118 Effects of Gallstones or Cholecystectomy on Gastrointestinal Cancer Risk and Prognosis: A Population-Based Cohort Study

Abstract

INTRODUCTION: It is debatable whether the gallstones or cholecystectomy increases gastrointestinal cancer (GIC) risk. We evaluated GIC risk and prognosis in gallstone patients treated with or without cholecystectomy and compared them with controls. METHODS: We identified gallstone patients (n = 480,688; follow-up: 12 years) and 1:10 age- and sex-matched healthy controls from Korean National Health Insurance data (2002–2016). Incidence and mortality rate of gastric cancer (GC), colon cancer (CC), rectal cancer (RC), hepatocellular carcinoma (HCC), bile duct cancer (BDC), and pancreatic cancer (PC) were compared. Possible risk factors such as sex, age, metabolic syndrome-related parameters (hypertension, obesity, hyperlipidemia, and hyperglycemia), liver enzyme levels, and smoking and drinking habits were adjusted. RESULTS: Compared to controls, gallstone patients without cholecystectomy revealed 0.78-, 0.95-, and 0.80-fold lower incidences of GC (88.87 per 105 person-year), CC (54.65), and RC (30.57) and 4.23-, 4.87-, and 1.60-fold higher incidences of HCC (107.69), BDC (33.85), and PC (22.29), respectively. Cholecystectomy was performed in 132,901 gallstone patients (27.6%); 87.5% of them were diagnosed with acute cholecystitis or cholangitis. Compared to gallstones without cholecystectomy, the incidences of gallstone patients treated with cholecystectomy revealed decreased in HCC (38.43) and BDC (13.90), increased in GC (107.32) and CC (59.58), and unchanged in RC (29.91) and PC (21.22). All GIC patients who underwent cholecystectomy had higher survival rates than controls. CONCLUSION: Risks of HCC, BDC, and PC were higher in gallstone patients, which decreased or unchanged after cholecystectomy. Gallstones or cholecystectomy had minimal effects on the incidences of GC, CC, and RC.