Cholecystectomy as a Risk Factor for Colorectal Cancer: A Meta-Analysis

Reid, Fiona; Mercer, Philippa; Harrison, Margo S.; Bates, Tom

doi:10.3109/00365529609031981

Cited by 72 publications

(52 citation statements)

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“…The case -control studies, however, suggested an increased risk of right-sided colon cancer (RR 1.88) with a minimally increased risk for left-sided colon cancer (RR 1.09). Two other meta-analyses reported similar results, with a particular elevation in the risk of proximal colon cancers (RR 1.52 and 1.86, respectively) (Bollschweiler et al, 1993;Reid et al, 1996). Only three large prospective cohort studies (Ekbom et al, 1993;Goldbohm et al, 1993;Lagergren et al, 2001) have examined the relation between cholecystectomy and colorectal cancer.…”

Section: Discussionmentioning

confidence: 80%

“…A meta-analysis of studies conducted through 1993 (Giovannucci et al, 1993) observed a modest increase in the risk of colorectal cancer following cholecystectomy, although the effect was restricted primarily to the proximal colon. Two subsequent meta-analyses (Bollschweiler et al, 1993;Reid et al, 1996) and three large prospective cohort studies (Ekbom et al, 1993;Goldbohm et al, 1993;Lagergren et al, 2001) also observed an increased risk of proximal cancers, particularly among women.Most studies that examined the relation between gallstones or cholecystectomy and colorectal cancer did not adjust for other risk factors for colorectal cancer, including diet. Therefore, among those studies demonstrating a positive association, one cannot exclude potential confounding by dietary or other lifestyle factors that are jointly associated with gallstones and colorectal cancer.…”

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Cholecystectomy and the risk for developing colorectal cancer and distal colorectal adenomas

et al. 2003

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Earlier work describes a modest association between cholecystectomy and the risk of colorectal cancer. We conducted a prospective study of 85 184 women, 36 -61 years old, who had no history of cancer to evaluate whether known risk factors for colorectal cancer, including dietary history, that have not been controlled for in previous analyses can help explain the observed association. During 16 years of follow-up, 877 cases of colorectal cancer were documented and 1452 women who underwent endoscopy during the follow-up time were diagnosed with distal adenomas. After adjustment for age and other known or suspected risk factors, we found a significant, positive association between cholecystectomy and the risk of colorectal cancer (multivariate relative risk RR 1.21, 95% CI 1.01 -1.46). The risk was highest for cancers of the proximal colon (RR 1.34, 95% CI 0.97 -1.88) and the rectum (RR 1.58, 95% CI 1.05 -2.36). However, we did not observe a significant association between cholecystectomy and distal colorectal adenomas. In this large prospective cohort study, a history of cholecystectomy appears to increase modestly the risk of colorectal cancer, even after adjustment for other colorectal cancer risk factors. More than 60 epidemiologic studies have investigated a possible relation between cholecystectomy and colon cancer risk. However, the strength of any association remains uncertain because of the small size and retrospective design with a failure to control for potential confounders of most analyses. A meta-analysis of studies conducted through 1993 (Giovannucci et al, 1993) observed a modest increase in the risk of colorectal cancer following cholecystectomy, although the effect was restricted primarily to the proximal colon. Two subsequent meta-analyses (Bollschweiler et al, 1993;Reid et al, 1996) and three large prospective cohort studies (Ekbom et al, 1993;Goldbohm et al, 1993;Lagergren et al, 2001) also observed an increased risk of proximal cancers, particularly among women.Most studies that examined the relation between gallstones or cholecystectomy and colorectal cancer did not adjust for other risk factors for colorectal cancer, including diet. Therefore, among those studies demonstrating a positive association, one cannot exclude potential confounding by dietary or other lifestyle factors that are jointly associated with gallstones and colorectal cancer.For the relation between cholecystectomy and colorectal cancer to be adequately characterised, large cohort studies with a long duration of follow-up and adequate assessment of potential confounding factors are necessary. We therefore utilised data from a prospective cohort study among women to illuminate further the influence of gallstones and cholecystectomy on the risk for colorectal cancer and distal colorectal adenoma. METHODS Study cohortThe Nurses' Health Study was initiated in 1976, when 121 700 female registered nurses of age 30 -55 and residing in the United States completed a mailed questionnaire on known or suspected risk factors for cancer ...

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Cholecystectomy and the risk for developing colorectal cancer and distal colorectal adenomas

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“…A history of chronic cholecystitis or cholecystectomy, chronic appendicitis or appendectomy, and chronic diarrhea also had higher sensitivity than HAP, indicating that these unique Chinese high risk factors can detect a larger number of advanced neoplasias. Some studies have found an increase in the risk of CRC following cholecystectomy for gallstones [21][22][23][24][25][26][27] . Cholecystectomy also influences the adenoma to cancer transition, ultimately predisposing to the development of CRC [28] .…”

Section: Discussionmentioning

confidence: 99%

Performance value of high risk factors in colorectal cancerscreening in China

Meng¹,

Cai²,

Zhou³

et al. 2009

WJG

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AIM:To analyze the performance value of high risk factors in population-based colorectal cancer (CRC) screening in China. METHODS:We compared the performance value of the immunochemical fecal occult blood test (iFOBT) and other high risk factors questionnaire in a population sample of 13 214 community residents who completed both the iFOBT and questionnaire investigation. Patients with either a positive iFOBT and/or questionnaire were regarded as a high risk population and those eligible were asked to undergo colonoscopy. RESULTS:The iFOBT had the highest positive predictive value and negative predictive value in screening for advanced neoplasia. The iFOBT had the highest sensitivity, lowest number of extra false positive results associated with the detection of one extra abnormality for screening advanced neoplasias and adenomas. A history of chronic cholecystitis or cholecystectomy, chronic appendicitis or appendectomy, and chronic diarrhea also had a higher sensitivity than a history of adenomatous polyps in screening for advanced neoplasias and adenomas. The sensitivity of a history of chronic cholecystitis or cholecystectomy was highest among the 10 high risk factors in screening for nonadenomatous polyps. A history of chronic appendicitis or appendectomy, chronic constipation, chronic diarrhea, mucous and bloody stool, CRC in first degree relatives, malignant tumor and a positive iFOBT also had higher sensitivities than a history of adenomas polyps in screening for non-adenomatous polyps. Except for a history of malignant tumor in screening for non-adenomatous polyps, the gain in sensitivity was associated with an increase in extra false positive results associated with the detection of one extra abnormality. CONCLUSION:The iFOBT may be the best marker for screening for advanced neoplasias and adenomas. Some unique high risk factors may play an important role in CRC screening in China.

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“…The results did not differ significantly by gender, colon subsite or time since diagnosis. British Journal of Cancer (2004) At least four large record linkage and cohort studies (Ekbom et al, 1993;Goldbohm et al, 1993;Johansen et al, 1996;Lagergren et al, 2001) and two meta-analyses (Giovannucci et al, 1993;Reid et al, 1996) found some increase of colorectal cancer risk following cholecystectomy. No association was found in another population-based cohort study from Sweden, including 150 colorectal cancer cases (Adami et al, 1987).…”

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Cholecystectomy and the risk of colorectal cancer in Italy

et al. 2004

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In two case -control studies from Italy covering 3533 cases of colorectal cancer and 7062 hospital controls, the odds ratios were 1.04 after cholecystectomy for colorectal, 1.08 for colon and 1.03 for rectal cancers. The results did not differ significantly by gender, colon subsite or time since diagnosis. British Journal of Cancer (2004) At least four large record linkage and cohort studies (Ekbom et al, 1993;Goldbohm et al, 1993;Johansen et al, 1996;Lagergren et al, 2001) and two meta-analyses (Giovannucci et al, 1993;Reid et al, 1996) found some increase of colorectal cancer risk following cholecystectomy. No association was found in another population-based cohort study from Sweden, including 150 colorectal cancer cases (Adami et al, 1987). The strength of the association, generally modest but significant in several studies (Ekbom et al, 1993;Giovannucci et al, 1993;Reid et al, 1996;Lagergren et al, 2001), has varied across different studies, colorectal subsites and sex (being somewhat stronger for proximal colon and for women). However different potential confounding factors and time since cholecystectomy have not always adequately been taken into account. Overweight and obesity are relevant risk factors for both gall bladder (Lew and Garfinkel, 1979;La Vecchia et al, 1991) and colorectal cancer (Lew and Garfinkel, 1979;Russo et al, 1998;Terry et al, 2001;Adami and Trichopoulos, 2003;Calle et al, 2003), and may therefore represent both an underlying pathogenetic mechanism and a potential confounding factor.In the Nurses' Health Study, including 877 women diagnosed with colorectal cancer, an increased relative risk (RR) of 1.21 (95% confidence interval (CI) 1.01 -1.46) was found in relation to history of gallstones or cholecystectomy (reported by 133 colorectal cancer cases), after adjusting for potential confounding factors (Schernhammer et al, 2003). The highest risks were reported for proximal colon (RR 1.34, 95% CI 0.97 -1.88) and rectum cancer (RR 1.58, 95% CI 1.05 -2.36).We have examined the relation between gallstones and colorectal cancer risk using data derived from two large Italian case -control studies on colorectal cancer, taking advantage of information on body size and of a comprehensive food-consumption questionnaire. MATERIALS AND METHODSThe first study was conducted between 1985 and 1991 in the greater Milan area (La Vecchia et al, 1988;Ferraroni et al, 1994), and the second one between 1991 and 1996 in six Italian areas: Greater Milan, the province of Pordenone, the urban area of Genoa and the province of Forlì, in northern Italy; the province of Latina, in central Italy; and the urban area of Naples, in southern Italy (La Vecchia et al, 1997). Overall, there were 3533 patients, aged 19 -79 years (median age 62) with incident (i.e. diagnosed within the year before interview), histologically confirmed cancer of the colon (2180 cases) or rectum (1353 cases), from the major teaching and general hospitals in areas under surveillance. Cancers of the colon and rectum and their anatomical subsit...

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Cholecystectomy as a Risk Factor for Colorectal Cancer: A Meta-Analysis

Abstract: It is possible that this small observed association may be due to a publication bias for positive results or bias within the included studies. If it is indeed a real effect, the risk to an individual is very small.

Cited by 72 publications

References 57 publications

Cholecystectomy and the risk for developing colorectal cancer and distal colorectal adenomas

Cholecystectomy and the risk for developing colorectal cancer and distal colorectal adenomas

Performance value of high risk factors in colorectal cancerscreening in China

Cholecystectomy and the risk of colorectal cancer in Italy

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