Abstract
Epidemiological findings suggest that gallstone disease and some frequent human cancers share common risk factors. In the present historical prospective cohort study, comprising 16,773 patients who had undergone cholecystectomy 12–15 years previously, the risk of developing gastric cancer was investigated. The total number of observed gastric cancers (89) was very close to the expected number (88), giving a relative risk (RR) of 1.01. A significantly increased risk (P<0.01; RR=2.67) of developing gastric cancer was found during the first year after cholecystectomy, and this increase was judged to be due to cancers that were present but overlooked at the time of cholecystectomy. Subgrouping according to age at surgery revealed a tendency towards a lower risk in patients operated on before the age of 70 years. It is concluded that our data do not support the hypothesis that there are common risk factors for gallstones and cancer, and cholecystectomy does not seem to be associated with an increased risk of gastric cancer within 15 years after this operation.
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Kalima T, Sjöberg J: Bile reflux after cholecystectomy. Scand J Gastroenterol Suppl 67:153–156, 1981
Koelsch KA, Kühne C, Zemlin C: Zustand nach Cholezystektomie; duodenogastraler Reflux und Gallensäurekonzentrationen im Magensaft. Z. Gesamte Inn Med 34:361–364, 1979
Goldstein F, Thornton JJ, Abramson J, Mcgroarty DJ, Kline JK: Bile reflux gastritis and esophagitis in patients without prior gastric surgery, with pilot study of the therapeutic effects of metoclopramide. Am J Gastroenterol 76:407–411, 1981
Warshaw AL: Bile gastritis without prior gastric surgery: Contributing role of cholecystectomy. Am J Surg 137:527–531, 1979
Buxbaum KL: Bile gastritis occurring after cholecystectomy. Am J Gastroenterol 77:305–311, 1982
Ritchie WR, Shearbum EW: Acute gastric mucosal ulcerogenesis is dependent on the concentration of bile salt. Surgery 80:98–104, 1976
Black RB, Hole D, Rhodes J: Bile damage to the gastric mucosal barrier, the influence of pH and bile acid concentration. Gastroenterology 61:178–184, 1971
Papachristou NP, Agnanti N, Fortner JG: Gastric carcinoma after treatment of ulcer. Am J Surg 139:193–196, 1980
Domellöf L: Gastric carcinoma promoted by alkaline reflux gastritis—with special reference to bile and other surfactants as promoters of postoperative gastric cancer. Med Hypoth 5:463–476, 1979
Domellöf L, Janunger KG: The risk for gastric carcinoma after partial gastrectomy. Am J Surg 134:581–584, 1977
Pomare EW, Heaton KW: The effect of cholecystectomy on bile salt metabolism. Gut 14:753–762, 1973
Hepner GW, Hofmann AF, Malagelada JR, Szcepanik PA, Klein PD: Increased bacterial degradation of bile acids in cholecystectomized patients. Gastroenterology 66:556–564, 1974
Malagelada JR, Go VLW, Summerskill WHJ, Gamble WS: Bile acid secretion and biliary bile acid composition altered by cholecystectomy. Am J Dig Dis 18:455–459, 1973
Narisawa T, Magadia NE, Weisburger JH, Wynder EL: Promoting effect of bile acids on colon carcinogenesis after intrarectal instillations ofN-methyl-N-nitro-N-nitrosoguanidine in rats. J Natl Cancer Inst 53:1093–1097 1974
Reddy BS, Narasawa T, Weisburger JH, Wynder EL: Promoting effect of sodium deoxycholate on colon adenocarcinomas in germfree rats. J Natl Cancer Inst 56:441–442, 1976
Lowenfels AB: Epidemiology. Gallstones and the risk of cancer. Gut 21:1090–1092, 1980
Lowenfels AB, Domellöf L, Lindstrom CG, Bergman F, Monk MA, Sternby NH: Cholelithiasis, cholecystectomy, and cancer: A case-control study in Sweden. Gastroenterology 83:672–676, 1982
Adami HO, Meirik O, Gustavsson S, Nyrén O, Krusemo UB: Colo-rectal cancer after cholecystectomy: Absence of risk increase within 15 years. Gastroenterology 85:859–865, 1983
Mattson B: Completeness of registration in the Swedish Cancer Registry. Stat Rep HS 1977:15, 1977
Mattson B: Reliability of identity number registration in the Swedish Cancer Registry. Stat Rep HS 1977:15, 1977
Linos DA, O'Fallon WM, Beart RW, Beard CM, Dockerty MB, Kurland LT: Cholecystectomy and cardinoma of the colon. Lancet 2:379–381, 1981
Turnbull PRG, Smith AH, Isbister W: Cholecystectomy and cancer of the large bowel. Br J Surg 68:551–553, 1981
Turunen MJ, Kivilaakso ED: Increased risk of colorectal cancer after cholecystectomy. Ann Surg 194:639–641, 1981
Domellöf L, Eriksson S, Janunger KG: Late occurrence of precancerous changes and carcinoma of the gastric stump after Billroth II resection. Acta Chir Scand 141:292–297, 1975
Kivilaakso E, Hakkiluoto A, Kalima TV, Sipponen P: Relative risk of stump cancer following partial gastrectomy. Br J Surg 64:336–338, 1977
McLean Ross AH, Smith MA, Anderson JR, Small WP: Late mortality after surgery for peptic ulcer. N Engl J Med 307:519–522, 1982
Kalima T, Sipponen J, Kivilaakso E, Sipponen P: Decreased prevalence of gallstones in gastric cancer. Am J Surg 144:531–533, 1982
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Supported by grants from the E. Eriksson Fund for Clinical Cancer research and the A. Karlsson Fund for Medical Research.
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Gustavsson, S., Adami, HO., Meirik, O. et al. Cholecystectomy as a risk factor for gastric cancer. Digest Dis Sci 29, 116–120 (1984). https://doi.org/10.1007/BF01317051
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DOI: https://doi.org/10.1007/BF01317051