Abstract
The number of patients subjected to cholecystectomy has increased since the introduction of laparoscopic methods. Therefore, the question of an association between colorectal cancer (CR-Ca) and cholecystectomy (CHE) is again topical. Several studies have been performed investigating the possibility of a link between cholecystectomy and large bowel cancer. The findings recorded in these studies have been varied and in some cases contradictory. In meta-analyses of the different types of studies (prospective and retrospective) the main question, “Is the risk of colorectal cancer higher after cholecystectomy?” was examined. In prospective matched-pairs studies, 1158 patients who had undergone CHE were compared with 1222 controls. The relative risk (RR) was 1.48, and this result was not significant. The four prospective cohort studies compared the frequency of CR-Ca of 22 783 CHE patients with the expected frequency in the population (RR = 0.99). The retrospective studies compared the frequency of previous CHE in 11797 patients with CR-Ca with the frequency in 33 940 controls without CR-Ca. The calculated odds ratio (O. R.) of the meta-analysis was 1.15, a significant but not clinically relevant increase in risk. Similar results was shown for evaluation of sex difference both in the prospective studies, with an RR of 0.99 for women and 1.00 for men, and in the retrospective studies, with a RR of 1.17 (p < 0.05) for women and 1.09 (n.s.) for men. The results for different location of the tumour show no significant risk differences in prospective studies either for the colon or for the rectum. Only the meta-analyses of retrospective studies also demonstrate a significant increase in risk of carcinomas of the colon (O. R. = 2.12, p < 0.001) and for the right hemicolon (O. R. = 1.52, p < 0.001).
Zusammenfassung
Durch die Einführung der laparoskopischen Cholezystektomie ist die Frage nach dem Einfluß der Gallenblasenentfernung auf die Entstehung von kolorektalen Karzinomen (CR-Ca) erneut aktuell geworden. Bisher vorliegende Studien zeigen widersprüchliche Ergebnisse. Durch eine Metaanalyse getrennt nach Studienart (prospektiv, retrospektiv) wurde die Häuptfragestellung „Wird das Risiko an einem kolorektalen Karzinom zu erkranken durch die Cholezystektomie erhöht?” untersucht. In den prospektiven Matched-pairs-Studien wurden 1 158 Patienten mit Cholezystektomie (CHE) mit 1 222 Kontrollen (Ko) verglichen. Das relative Risiko (RR) war mit 1,48 nicht significant erhöht. In 4 prospektiven Kohortenstudien wurde die Häufigkeit des CR-Ca von 22 783 Patienten mit CHE verglichen mit der zu erwartenden Häufigkeit (RR = 0,99). In den retrospektiven Studien wurde die Häufigkeit einer vorhergehenden CHE bei 11 797 Patienten mit CR-Ca mit der Häufigkeit bei 33 940 Kontrollen ohne CR-Ca verglichen. Die berechnete „odds ratio” (O. R.) der Metaanalyse betrug 1,15, was eine signifikante aber klinisch nichtrelevante Risikoerhöhung darstellt. Ähnliche Werte ergaben sich für die getrennte Auswertung nach Geschlecht sowohl in der Analyse der prospektiven Studien mit einem RR von 0,99 für Frauen and 1,00 für Männer und für die retrospektiven Studien mit 1,17 (p < 0,05) für Frauen und 1,09 (n.s.) für Männer. Die Ergebnisse unter Berücksichtigung der Lokalisation des Tumors zeigen für die prospektiven Untersuchungen weder für das Kolon Ca noch für das Rectum Ca signifikante Risikoerhöhungen. Nur in der Analyse der retrospektiven Studien ergibt sich für das Kolon Ca eine signifikante Risikoerhöhung (O. R. = 2,12, p < 0,001) und dies läßt sich insbesondere für Karzinome des rechten Hemikolons nachweisen (O. R. = 1,52, p > 0,001).
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Bollschweiler, E., Feussner, H., Huber, F. et al. Ist die Cholezystektomie ein Risikofaktor für das kolorektale Karzinom?. Langenbecks Arch Chir 378, 304–312 (1993). https://doi.org/10.1007/BF00183969
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DOI: https://doi.org/10.1007/BF00183969