J Korean Med Sci.  2020 Nov;35(42):e354. 10.3346/jkms.2020.35.e354.

Prevalence and Risk Factors of Gastric and Colorectal Cancer after Cholecystectomy

• Kim SB
• Kim KO
• Kim TN

• KMID: 2508430
• DOI: http://doi.org/10.3346/jkms.2020.35.e354

Abstract

Background
Previous studies on the relationship between gastrointestinal (GI) cancer and cholecystectomy remain inconclusive. We aimed to evaluate this relationship, albeit particularly between cholecystectomy and gastric cancer or colorectal cancer (CRC), and the risk factors of cancer among individuals who have undergone cholecystectomy in Korea.
Methods
In total, 4,222 patients who underwent laparoscopic or open cholecystectomy at our institution between January 2006 and December 2013 were included. Patients who underwent cholecystectomy for gallbladder cancer or were undergoing surgery for GI, hepatic, or pancreatobiliary cancers were excluded, as were those who developed stomach cancer or CRC within a year of their cholecystectomy. The included patients were followed until July 20, 2020. The standardized incidence ratio (SIR) was used to calculate the relative risk of GI cancer in cholecystectomy patients.
Results
The median patient age (n = 3,588) at the time of cholecystectomy was 54.0 (range, 19–95) years, and the male-to-female ratio was 1:1.04. The median follow-up period after cholecystectomy was 15.0 (range, 0–146) months. We found a 108% greater risk of CRC (SIR, 2.08; 95% confidence interval [CI], 1.28–3.17) and 154% increased risk of CRC in females (SIR, 2.54; 95% CI, 1.16–4.84). Based on multivariate analysis, an age of > 60 years was a significant risk factor for GI cancer in cholecystectomy patients.
Conclusion
Cholecystectomy may increase risk of CRC, especially in females. Age was considered a risk factor of GI cancers in patients with history of cholecystectomy.

Keyword

Cholecystectomy; Stomach Cancer; Colorectal Cancer

Reference

1. Reid FD, Mercer PM, harrison M, Bates T. Cholecystectomy as a risk factor for colorectal cancer: a meta-analysis. Scand J Gastroenterol. 1996; 31(2):160–169. PMID: 8658039.

2. Sonne DP, Hare KJ, Martens P, Rehfeld JF, Holst JJ, Vilsbøll T, et al. Postprandial gut hormone responses and glucose metabolism in cholecystectomized patients. Am J Physiol Gastrointest Liver Physiol. 2013; 304(4):G413–G419. PMID: 23275610.

3. Bernstein C, Holubec H, Bhattacharyya AK, Nguyen H, Payne CM, Zaitlin B, et al. Carcinogenicity of deoxycholate, a secondary bile acid. Arch Toxicol. 2011; 85(8):863–871. PMID: 21267546.

4. Ge Z, Zhao C, Wang Y, Qian J. Cholecystectomy and the risk of esophageal and gastric cancer. Saudi Med J. 2012; 33(10):1073–1079. PMID: 23047213.

5. Nogueira L, Freedman ND, Engels EA, Warren JL, Castro F, Koshiol J. Gallstones, cholecystectomy, and risk of digestive system cancers. Am J Epidemiol. 2014; 179(6):731–739. PMID: 24470530.

6. Chow WH, Johansen C, Gridley G, Mellemkjaer L, Olsen JH, Fraumeni JF Jr. Gallstones, cholecystectomy and risk of cancers of the liver, biliary tract and pancreas. Br J Cancer. 1999; 79(3-4):640–644. PMID: 10027343.

7. Fall K, Ye W, Nyrén O. Risk for gastric cancer after cholecystectomy. Am J Gastroenterol. 2007; 102(6):1180–1184. PMID: 17355416.

8. Todoroki I, Friedman GD, Slattery ML, Potter JD, Samowitz W. Cholecystectomy and the risk of colon cancer. Am J Gastroenterol. 1999; 94(1):41–46. PMID: 9934729.

9. Kellosalo J, Alavaikko M, Laitinen S. Effect of biliary tract procedures on duodenogastric reflux and the gastric mucosa. Scand J Gastroenterol. 1991; 26(12):1272–1278. PMID: 1763297.

10. Dixon MF, Genta RM, Yardley JH, Correa P. Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. Am J Surg Pathol. 1996; 20(10):1161–1181. PMID: 8827022.

11. Bailar JC, Ederer F. 202. Note: significance factors for the ratio of a poisson variable to its expectation. Biometrics. 1964; 20(3):639–643.

12. Manifold DK, Anggiansah A, Owen WJ. Effect of cholecystectomy on gastroesophageal and duodenogastric reflux. Am J Gastroenterol. 2000; 95(10):2746–2750. PMID: 11051343.

13. Chen YK, Yeh JH, Lin CL, Peng CL, Sung FC, Hwang IM, et al. Cancer risk in patients with cholelithiasis and after cholecystectomy: a nationwide cohort study. J Gastroenterol. 2014; 49(5):923–931. PMID: 23807230.

14. Zhang Y, Liu H, Li L, Ai M, Gong Z, He Y, et al. Cholecystectomy can increase the risk of colorectal cancer: a meta-analysis of 10 cohort studies. PLoS One. 2017; 12(8):e0181852. PMID: 28771518.

15. Haggar FA, Boushey RP. Colorectal cancer epidemiology: incidence, mortality, survival, and risk factors. Clin Colon Rectal Surg. 2009; 22(4):191–197. PMID: 21037809.

16. Karimi P, Islami F, Anandasabapathy S, Freedman ND, Kamangar F. Gastric cancer: descriptive epidemiology, risk factors, screening, and prevention. Cancer Epidemiol Biomarkers Prev. 2014; 23(5):700–713. PMID: 24618998.

17. Rawla P, Barsouk A. Epidemiology of gastric cancer: global trends, risk factors and prevention. Prz Gastroenterol. 2019; 14(1):26–38. PMID: 30944675.