Abstract
Background: Cancer development after cholecystectomy remains debatable. We estimated the major cancer incidence rates after cholecystectomy stratified by age and sex. Methods: The records of 408,769 subjects aged >20 years were extracted from the National Health Insurance database from 2008 to 2016. The risks of major cancers were compared between the cholecystectomy and general populations using standardised incidence ratios (SIR). Results: The overall cancer incidence was comparable between cholecystectomy patients and the general population. However, patients aged <65 years who underwent cholecystectomy had a higher cancer risk than those aged ≥65 years and the general population (SIR 2.62; 95% confidence interval [CI] 2.15–3.08; SIR 1.36, 95% CI 1.32–1.40; and SIR 0.90, 95% CI 0.87–0.92 in men and SIR 1.91; 95% CI 1.71–2.10; SIR 1.07; 95% CI 1.03–1.10; and SIR 0.90; 95% CI 0.87–0.94 in women aged 20–34, 35–64, and ≥65 years at cholecystectomy). Colorectal and liver cancer incidences after cholecystectomy were higher than those in the general population regardless of age group and sex (SIR, 1.55 for colorectal cancer in men and women; SIR, 1.25 and 1.51 for liver cancer in men and women, respectively). However, for other major cancers, the risk was higher in patients who underwent cholecystectomy at a younger age than in those who underwent cholecystectomy at an age ≥65 years. Conclusion: Patients with cholecystectomy, especially those undergoing cholecystectomy at a younger age, need preventive strategies based on the cancer type.
Highlights
Cholecystectomy is the sixth most common operation in Korea and the number of operations performed per year has been increasing rapidly
It has been suggested that cancer is one of the first health problems that occur after cholecystectomy, based on two hypotheses: first, the change in bile acid flow after cholecystectomy and the subsequent increase in duodeno-gastric bile reflux followed by direct contact of bile acid with the intestinal wall [3,4,5] may cause cancer; and second, cancer risk related to chronic inflammation [6,7]
Previous population-based studies have shown an increase in the overall cancer risk in patients with cholelithiasis or cholecystitis [25]
Summary
Cholecystectomy is the sixth most common operation in Korea and the number of operations performed per year has been increasing rapidly. The two most common causes for cholecystectomy are cholelithiasis (gallstones) and cholecystitis (inflammation of the gallbladder) [1]. This steep increment in the number of surgeries is attributed to factors such aging and changes in eating habits [2], and the number of cholecystectomies is expected to increase further. The risks of major cancers were compared between the cholecystectomy and general populations using standardised incidence ratios (SIR). Colorectal and liver cancer incidences after cholecystectomy were higher than those in the general population regardless of age group and sex (SIR, 1.55 for colorectal cancer in men and women; SIR, 1.25 and 1.51 for liver cancer in men and women, respectively). Conclusion: Patients with cholecystectomy, especially those undergoing cholecystectomy at a younger age, need preventive strategies based on the cancer type
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