The Effect of Cholecystectomy on the Risk of Colorectal Cancer in Patients with Gallbladder Stones.

Chien-Hua Chen,Chia-Hung Kao,Cheng-Li Lin

doi:10.3390/cancers12030550

Abstract

To evaluate the risk of colorectal cancer (CRC) after cholecystectomy for gallbladder stones (GBS). Methods: This nationwide population-based cohort study analyzed the inpatient data from the Taiwan National Health Insurance Research Database. The study cohort comprised of 83,963 patients aged ≥ 20 years undergoing cholecystectomy for GBS between 2000 and 2010. The control cohort comprised the GBS patients without cholecystectomy, who were propensity matched with the study cohort at a 1:1 ratio based on age, sex, comorbidities, and the index date for cholecystectomy. Results: The cumulative incidence of CRC within 6 months of follow-up was higher in the cholecystectomy cohort than that in the non-cholecystectomy cohort (aHR (adjusted hazard ratio) = 7.90, 95% confidence interval (CI) = 6.27–9.94; log-rank test, p < 0.001). The cumulative incidence of CRC after 6 months of follow-up was lower in the cholecystectomy cohort than that in the non-cholecystectomy cohort (aHR = 0.66, 95% CI = 0.60–0.73; log-rank test, p < 0.001), but the reduced risk of CRC for the cholecystectomy cohort was statistically significant only in rectal cancer after separately considering females (aHR = 0.64, 95% CI = 0.46–0.88) and males (aHR = 0.59, 95% CI = 0.44–0.79). Conclusions: The positive association between cholecystectomy and the CRC risk within the first 6 months after cholecystectomy might be due to a detection bias or pre-existing CRC. However, cholecystectomy is associated with a decreased risk of rectal cancer, rather than proximal or distal colon cancer, after more than 6 months of follow-up.

Highlights

Colorectal cancer (CRC) ranks as the third most common malignancy for men and the second most common malignancy for women worldwide [1]
The cholecystectomy and non-cholecystectomy cohorts matched for age, occupation, urbanizationlevel, level,and andcomorbidities
Our results show that the risk of CRC in patients with gallbladder stones (GBS) would decrease after cholecystectomy when the follow-up period was greater than 6 months

Summary

Introduction

Colorectal cancer (CRC) ranks as the third most common malignancy for men and the second most common malignancy for women worldwide [1]. Cancers 2020, 12, 550 common malignancy-associated mortality globally [1,2]. With global industrialization and urbanization, approximately 1,800,000 new cases and 881,000 deaths have been diagnosed with CRC in 2018 globally the CRC mortality has decreased for the last decades in Western countries [1,3]. In Taiwan, the age-standardized incidence rate of CRC has increased from 25.46/100,000 persons in 2002 to 43.0/100,000 persons in 2015 [4]. The age-standardized mortality rate of CRC was 11.6/100,000 persons in 2017 and CRC has remained as the third commonest malignancy-associated mortality in Taiwan [4].

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Conclusion