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The role of previous cholecystectomy in patients with colorectal cancer

A meta-analysis and review

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Coloproctology Aims and scope

Summary

There is a large body of literature which undertakes to look at a possible association between cholecystectomy and colorectal cancer. We set out to conduct a meta-analysis to investigate this. The overall odds ratio for all studies looked at was 1.36 with 95% confidence intervals (CI) 1.07 to 1.74, significant at the 5% level (p=0.014). The overall odds ratio for a subset of studies deemed “good studies” established by a customised ranking score was 1.66 (1.34 to 2.03), p<0.0001. The odds ratios for cohort and necropsy studies were also ascertained and discussed. Our results would tend to support the above hypothesis. However, the limitations of this review are also discussed, and finally we suggest that if such an association is indeed real then the increased risk is likely to be small.

Zusammenfassung

Es existiert zahlreiche Literatur über einen möglichen Zusammenhang von Cholezystektomie und kolorektalem Karzinom. Wir initiierten deshalb eine Metaanalyse, um diese Möglichkeit zu überprüfen. Das gesamte Wahrscheinlichkeitsverhältnis aller ausgewerteten Untersuchungen lag bei 1,36 mit einem Vertrauensintervall von 95% (1,07 bis 1,74); Signifikanz war bei 5% gegeben (p=0,014). Das gesamte Wahrscheinlichkeitsverhältnis für einen Teil der Untersuchungen, die als „gute Untersuchungen” anzusehen waren und für die ein einheitliches Bewertungssystem vorlag, betrug 1,66 (1,34 bis 2,03, p=0,0001). Das Wahrscheinlichkeitsverhältnis für Sammel- und Autopsiestudien wurde ebenfalls überprüft und diskutiert. Unsere Ergebnisse unterstützen die vorgenannte Hypothese. Allerdings werden auch die Grenzen dieser Übersicht diskutiert, wobei wir schlußfolgernd davon ausgehen, daß eine solche Assoziation sehr klein ist, falls sie tatsächlich existiert.

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References

  1. Abrams, J. S., J. R. Anton, D. C. Dreyfuss: The absence of a relationship between cholecystectomy and the subsequent occurrence of cancer of the proximal colon. Dis. Colon Rect. 26 (1983), 141–144.

    Article  CAS  Google Scholar 

  2. Adami, H. O., U. B. Krusemo, O. Meirik: Unaltered risk of colorectal cancer within 14–17 years of cholecystectomy: updating of a population based cohort study. Brit. J. Surg. 74 (1987), 675–678.

    Article  PubMed  CAS  Google Scholar 

  3. Adami, H. O., O. Meirik, S. Gustavsson: Colorectal cancer after cholecystectomy: absence of risk increase within 11–14 years. Gastroenterology 85 (1983), 859–865.

    PubMed  CAS  Google Scholar 

  4. Allende, H. D., F. V. Ona, H. T. Davis: Gallbladder disease: risk factor for colorectal carcinoma? J. clin. Gastroent. 6 (1984), 51–55.

    PubMed  CAS  Google Scholar 

  5. Alley, P. G., S. P. Lee: The increased risk of proximal colon cancer after cholecystectomy. Dis. Colon Rect. 26 (1983), 522–524.

    Article  CAS  Google Scholar 

  6. Almond, H. R., Z. R. Vlahcevic, C. R. Bell: Bile acid pools, kinetics, and biliary lipid composition — before and after cholecystectomy. New Engl. J. Med. 1 (1978), 213–216.

    Google Scholar 

  7. Barker, W. H.: Cholecystectomy and colon cancer. Lancet 2 (1981), 986.

    Article  PubMed  CAS  Google Scholar 

  8. Bennion, L. J., S. M. Grundy: Risk factors for the development of cholelithiasis in man. New Engl. J. Med. 299 (1978), 1161–1167.

    PubMed  CAS  Google Scholar 

  9. Berkel, J., D. A. M. A. Hombergen, I. E. Hooymayers: Cholecystectomy and colon cancer: Amer. J. Gastroent. 85 (1990), 61–64.

    CAS  Google Scholar 

  10. Blanco, D., R. K. Ross, A. Paganini-Hill: Cholecystectomy and colonic cancer. Dis. Colon Rect. 27 (1984), 290–292.

    Article  CAS  Google Scholar 

  11. Breslow, N. E., D. G. Clayton: Approximate inference in generalized mixed models. J. Amer. stat. Ass. 88 (1993), 9–25.

    Article  Google Scholar 

  12. Breuer, N. F., B. Katschinski, E. Mortl: Large bowel cancer risk in cholelithiasis after cholecystectomy. Digestion 40 (1988), 219–226.

    Article  PubMed  CAS  Google Scholar 

  13. Bundred, N. J., B. C. S. Whitfield, E. Stanton: Cholecystectomy, cholelithiasis and colorectal carcinoma. J. roy. Coll. Surg. Edinb. 30 (1985), 115–117.

    PubMed  CAS  Google Scholar 

  14. Burkitt, D. P.: Possible relationships between bowel cancer and dietary habits. Proc. roy. Soc. Med. 64 (1971), 964–965.

    PubMed  CAS  Google Scholar 

  15. Capron, J. P., J. Delamarre, J. P. Canarelli: Does cholecystectomy predispose to the development of colorectal cancer? Gastroent. clin. Biol. 2 (1978), 383–389.

    PubMed  CAS  Google Scholar 

  16. Carey, W. D., E. Achkar: Colon polyps and cancer in 1994. Amer. J. Gastroent. 89 (1994), 823–824.

    PubMed  CAS  Google Scholar 

  17. Castleden, W. M., T. W. Douss, K. P. Jennings: Gallstones, carcinoma of the colon, and diverticular disease. Clin. Oncol. 4 (1978), 139–144.

    PubMed  CAS  Google Scholar 

  18. Colton, T.: Statistics in medicine. Little, Brown, Boston 1974, p. 4–7.

    Google Scholar 

  19. Damale, E. H., K. W. Heaton: The effect of cholecystectomy on bile salt metabolism. Gut 14 (1973), 753–763.

    Article  Google Scholar 

  20. Doll, R.: Cancer in five continents. Proc. roy. Soc. Med. 65 (1972), 49–55.

    PubMed  CAS  Google Scholar 

  21. Douss, T. W., W. M. Castleden: Gallstones and carcinoma of the large bowel. N. Z. Med. J. 77 (1973), 162–165.

    Google Scholar 

  22. Ekbom, A., J. Yuen, H.-O. Adami: Cholecystectomy and colorectal cancer. Gastroenterology 105 (1993), 142–147.

    PubMed  CAS  Google Scholar 

  23. Eriksson, S. G., C. G. Lindstrom: Lack of relationship between cholecystectomy and colorectal cancer. A case control autopsy study in a defined population. Scand. J. Gastroent. 19 (1984), 977–982.

    PubMed  CAS  Google Scholar 

  24. Fixa, B., O. Komarkova, K. Zaydlar: Is there an increased risk of colorectal cancer after cholecystectomy? Neoplasma 32 (1985), 513–517.

    PubMed  CAS  Google Scholar 

  25. Friedman, G. D., M. K. Goldhaber, C. P. Quesenberry Jr.: Cholecystectomy and large bowel cancer. Lancet 1 (1987), 906–908.

    Article  PubMed  CAS  Google Scholar 

  26. Gafa, M., L. Sarli, G. Sansebastiano: Gallstones and the risk of colonic cancer: a matched case control study. Int. Surg. 72 (1987), 20–24.

    PubMed  CAS  Google Scholar 

  27. Gafa, M., L. Sarli, G. Sansebastiano: Prevention of colorectal cancer. Role of the association between gallstones and colorectal cancer. Dis. Colon Rect. 30 (1987), 692–696.

    Article  CAS  Google Scholar 

  28. Gershon, W., M. D. Hepner, A. F. Hofmann: Increased bacterial degradation of bile acids in cholecystectomized patients. Gastroenterology 66 (1974), 556–564.

    Google Scholar 

  29. Giovannucci, E., G. A. Colditz, M. J. Stampfer: A meta-analysis of cholecystectomy and risk of colorectal cancer. Gastroenterology 105 (1993), 130–141.

    PubMed  CAS  Google Scholar 

  30. Hepner, G. W., A. F. Hofmann, J. R. Malagelada: Increased bacterial degradation of bile acids in cholecystectomized patients. Gastroenterology 307 (1982), 798–800.

    Google Scholar 

  31. Hill, M. J.: Steroid nuclear dehydrogenation and colon cancer. Amer. J. clin. Nutr. 27 (1974), 1475–1480.

    PubMed  CAS  Google Scholar 

  32. Hill, M. J.: The role of colon anaerobes in the metabolism of bile acids and steroids, and its relation to colon cancer. Cancer 36 (1975), 2387–2400.

    Article  PubMed  CAS  Google Scholar 

  33. Hill, M. J., J. S. Crowther, B. S. Drasar: Bacteria and aetiology of cancer of large bowel. Lancet 1 (1971), 95–100.

    Article  PubMed  CAS  Google Scholar 

  34. Hilton, R., Z. Almond, R. Vlahcevic: Bile acid pools, kinetics and biliary lipid composition before and after cholecystectomy. New Engl. J. Med. 289 (1973), 1213–1216.

    Google Scholar 

  35. Hoare, A. M.: Carcinoma of the colon and cholecystectomy (letter). Lancet 2 (1974), 1395.

    Article  PubMed  CAS  Google Scholar 

  36. Jorgensen, T., S. Rafaelsen: Gallstones and colorectal cancer. There is a relationship, but it is hardly due to cholecystectomy. Dis. Colon Rect. 35 (1992), 24–28.

    Article  CAS  Google Scholar 

  37. Kaibara, N., T. Wakatsuki, K. Mizusawa: Negative correlation between cholecystectomy and the subsequent development of large bowel carcinoma in a low risk Japanese population. Dis. Colon Rect. 29 (1986), 644–646.

    Article  CAS  Google Scholar 

  38. Kato, I., K. Kato, S. Akai: A case control study of gallstones, a major risk factor for biliary tract cancer. Jap. J. Cancer Res. 81 (1990), 578–583.

    CAS  Google Scholar 

  39. Kullack-Ublick, G.-A., G. Paumgartner, F. Berr: Longterm effects of cholecystectomy on bile acid metabolism. Hepatology 21 (1995), 41–45.

    Google Scholar 

  40. Kune, G. A., S. Kune, L. F. Watson: Large bowel cancer after cholecystectomy. Amer. J. Surg. 156 (1988), 359–362.

    Article  PubMed  CAS  Google Scholar 

  41. Kwai, A. H.: Cholecystectomy and large bowel cancer. Mt. Sinai J. Med. 50 (1983), 359–363.

    PubMed  CAS  Google Scholar 

  42. Lee, H. P., L. Gourly, S. W. Duffy: Colorectal cancer and diet in an Asian population — a case control study among Singapore Chinese. Int. J. Cancer 43 (1989), 1007–1016.

    Article  PubMed  CAS  Google Scholar 

  43. Lee, S. S., S. Cha, R. L. Lee: The relationship between cholecystectomy and colon cancer: an Iowa study. J. surg. Oncol. 41 (1989), 81–85.

    Article  PubMed  CAS  Google Scholar 

  44. Lew, E. A., L. Garfinkel: Variations in mortality by weight among 750,000 men and women. J. chron. Dis. 32 (1979), 563–576.

    Article  PubMed  CAS  Google Scholar 

  45. Linos, D. A., W. M. O’Fallon, R. W. Beart: Cholecystectomy and carcinoma of the colon. Lancet 2 (1981), 379–381.

    Article  PubMed  CAS  Google Scholar 

  46. Llamas, K. J., L. G. Torlach, M. Ward: Cholecystectomy and adenomatous polyps of the large bowel. Gut 27 (1986), 1181–1185.

    Article  PubMed  CAS  Google Scholar 

  47. Lowenfels, A. B., L. Domellof, C. G. Lindstrom: Cholelithiasis, cholecystectomy, and cancer: a case control study in Sweden. Gastroenterology 83 (1982), 672–676.

    PubMed  CAS  Google Scholar 

  48. Lowenfels, A. B., R. Schwartz, C. Pitchumoni: Cholelithiasis and cancer (abstract). Gastroenterology 80 (1981), 1218.

    Google Scholar 

  49. Maclure, R. M., K. C. Hayes, G. A. Colditz: Weight, diet, and the risk of symptomatic gallstones in middle aged women. New Engl. J. Med. 321 (1989), 563–569.

    Article  PubMed  CAS  Google Scholar 

  50. Malagelada, J. R., V. W. L. Go, W. H. J. Summerskill: Bile acid secretion and biliary bile composition altered by cholecystectomy. Amer. J. dig. Dis. (1973), 455–459.

  51. Mamianetti, A., R. O. Cinto, D. Altolaguirre: Relative risk of colorectal cancer after cholecystectomy. A multicentre case-control study. Int. J. colorect. Dis. 3 (1988), 215–218.

    Article  CAS  Google Scholar 

  52. Mannes, A. G., M. Weinzierl, F. Stellard: Adenomas of the large intestine after cholecystectomy. Gut 25 (1984), 863–866.

    Article  PubMed  CAS  Google Scholar 

  53. Manoussos, O. N., F. Gerovassilis, C. Papadimitriou: Cholecystectomy and colon cancer (letter). Lancet 2 (1981), 810.

    Article  Google Scholar 

  54. Maringhini, A., J. A. Moreau, L. J. Melton: Gallstones, gallbladder cancer, and other gastrointestinal malignancies. An epidemiological study in Rochester Minnesota. Ann. intern. Med. 107 (1987), 30–35.

    PubMed  CAS  Google Scholar 

  55. Markman, M.: Cholecystectomy and carcinoma of the colon. Lancet 2 (1982), 47.

    Article  PubMed  CAS  Google Scholar 

  56. Mastromarino, A., B. S. Reddy, E. L. Wynder: Metabolic epidemiology of colon cancer. Amer. J. clin. Nutr. 29 (1976), 1455–1460.

    PubMed  CAS  Google Scholar 

  57. McFarlane, M. J., K. E. Welch: Gallstones, cholecystectomy and colorectal cancer. Amer. J. Gastroent. 88 (1993), 1994–1999.

    PubMed  CAS  Google Scholar 

  58. Moorehead, R. J., S. T. D. McKelvey: Cholecystectomy and colorectal cancer. Brit. J. Surg. 76 (1989), 250–253.

    Article  PubMed  CAS  Google Scholar 

  59. Moorehead, R. J., R. M. Kernohan, C. C. Patterson: Does cholecystectomy predispose to colorectal cancer? Dis. Colon Rect. 29 (1986), 36–38.

    Article  CAS  Google Scholar 

  60. Moorehead, R. J., H. K. Wilson, J. O. M. Mills: Cholecystectomy, development of colorectal neoplasia: a prospective study. Ann. roy. Coll. Surg. Engl. 71 (1989), 36–39.

    Google Scholar 

  61. Narisawa, T., M. Sano, M. Sato: Relation between cholecystectomy and colonic cancer in a low risk Japanese population. A preliminary study. Amer. Soc. Colon rect. Surg. 26 (1983), 512–514.

    Article  CAS  Google Scholar 

  62. Neugut, A. I., C. M. Johnsen, K. A. Forde: Cholecystectomy and adenomatous polyps of the colon in women. Cancer 61 (1988), 618–621.

    Article  PubMed  CAS  Google Scholar 

  63. Neugut, A. I., T. I. Murray, G. C. Garbowski: Cholecystectomy as a risk factor for colorectal adenomatous polyps and carcinoma. Cancer 68 (1991), 1644–1647.

    Article  PubMed  CAS  Google Scholar 

  64. Nielson, G. P., A. Theodors, H. Tulinius: Cholecystectomy and colorectal carcinoma: a total population historical prospective study. Amer. J. Gastroent. 86 (1991), 1486–1490.

    Google Scholar 

  65. Paul, J., F. Gessner, J. G. Weschler: Increased incidence of gall-stones and prior cholecystectomy in patients with large bowel cancer. Amer. J. Gastroent. 87 (1992), 1120–1124.

    PubMed  CAS  Google Scholar 

  66. Pomare, E. W., K. W. Heaton: The effect of cholecystectomy on bile salt metabolism. Gut 14 (1973), 753–762.

    Article  PubMed  CAS  Google Scholar 

  67. Reddy, B. S., T. Narisawa, J. H. Weisburger: Promoting effect of deoxycholate on colon adenocarcinoma in germ-free rats. J. nat. Cancer Inst. 56 (1976), 441–442.

    PubMed  CAS  Google Scholar 

  68. Rundgren, A., D. Mellstrom: Cholecystectomy and colon cancer in the elderly. Age and Ageing 12 (1983), 44–49.

    Article  PubMed  CAS  Google Scholar 

  69. Sandler, R. S., Z. Z. Martin, N. M. Carlton: Adenomas of the large bowel after cholecystectomy. A case control study. Dig. Dis. Sci. 33 (1988), 1178–1184.

    Article  PubMed  CAS  Google Scholar 

  70. Schattenkerk, M. E., A. K. C. Li, B. W. Jeppsson: Cholecystectomy has no influence on the frequency of chemically induced colonic cancer in mice. Brit. J. Cancer 42 (1980), 791.

    PubMed  CAS  Google Scholar 

  71. Schoen, R. E., J. L. Weissfield, L. H. Kuller: Are women with breast, endometrial or ovarian cancer at increased risk for colorectal cancer. Amer. J. Gastroent. 89 (1994), 835–842.

    PubMed  CAS  Google Scholar 

  72. Soltero, E., N. Cruz, C. M. Nazario: Cholecystectomy and right sided colorectal cancer in Puerto Rico. Cancer 66 (1990), 2249–2252.

    Article  PubMed  CAS  Google Scholar 

  73. Sonoda, T., D. J. Youngman, R. D. Reynolds: Cholecystectomy and carcinoma of the colon. Milit. Med. 148 (1983), 721–722.

    CAS  Google Scholar 

  74. Spitz, M. R., N. C. Russell, V. F. Guinee: Questionable relationship between cholecystectomy and colon cancer. J. surg. Oncol. 30 (1985), 6–9.

    Article  PubMed  CAS  Google Scholar 

  75. Turnbull, P. R. G., A. H. Smith, W. H. Isbister: Brit. J. Surg. 68 (1981), 551–553.

    Article  PubMed  CAS  Google Scholar 

  76. Turunen, M. J., E. O. Kivilaakso: Increased risk of colorectal cancer after cholecystectomy. Ann. Surg. 194 (1981), 639–641.

    Article  PubMed  CAS  Google Scholar 

  77. Van Den Linden, W., B. Katzenstein, F. Nakayama: The possible carcinogenic effect of cholecystectomy. No postoperative increase in the proportion of secondary bile acids. Cancer 52 (1983), 1265–1268.

    Article  PubMed  Google Scholar 

  78. Van de Werf, S. D. J., F. M. Nagengast, G. P. van Berge Henegowen: Colonic absorption of secondary bile acids in patients with adenomatous polyps and in matched controls. Lancet 1 (1982), 759–761.

    PubMed  Google Scholar 

  79. Vernick, L. J., L. H. Kuller: A case control study of cholecystectomy and right-side colon cancer. Amer. J. Epidem. 116 (1982), 86–101.

    CAS  Google Scholar 

  80. Vernick, L. J., L. H. Kuller, P. Lohsoonthorn: Relationship between cholecystectomy and ascending colon cancer. Cancer 45 (1980), 392–395.

    Article  PubMed  CAS  Google Scholar 

  81. Vobecky, J., J. Caro, G. Devroede: A case control study of risk factors for large bowel carcinoma. Cancer 51 (1983), 1958–1963.

    Article  PubMed  CAS  Google Scholar 

  82. Weiss, N. S., J. R. Daling: Cholecystectomy and incidence of cancer of the large bowel. Cancer 49 (1982), 1713–1715.

    Article  PubMed  CAS  Google Scholar 

  83. Werner, B., K. deHeer, H. Mitschke: Cholecystectomy and carcinoma of colon. An experimental study. Z. Krebsforsch. 88 (1977), 223–230.

    Article  CAS  Google Scholar 

  84. Wu, A. H., A. Paganini-Hill, R. K. Ross: Alcohol, physical activity and other risk factors for colorectal cancer: a prospective study. Brit. J. Cancer 55 (1987), 687–694.

    PubMed  CAS  Google Scholar 

  85. Wynder, E. L., B. S. Reddy: Metabolic epidemiology of colorectal cancer. Cancer 34 (1974), 801–806.

    Article  PubMed  Google Scholar 

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  1. Department of Medicine, Royal Infirmary of Edinburgh, UK

    E. Kyriacou

  2. Department of Medicine, Public Health, Glasgow University, UK

    R. Knill-Jones

  3. c/o Boundaries, St. James’s Rd, Hampton Hill, TW12 1DH, Hampton Middlesex, England, UK

    E. Kyriacou

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Kyriacou, E., Knill-Jones, R. The role of previous cholecystectomy in patients with colorectal cancer. Coloproctol 19, 77–83 (1997). https://doi.org/10.1007/BF03043692

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