Abstract
Background
Currently, there is a scarcity of concrete evidence regarding the connection between cholecystectomy and the risk of developing gastrointestinal (GI) cancer. Our main objective was to delve deeper into this association further and explore any potential relationships.
Method
We extracted more than 20 million medical reimbursement records from the healthcare database of the Shanghai Medical Insurance Center in 2007. Following a predetermined screening strategy using the International Classification of Diseases (ICD), we continued our observation of the medical records of the screened patients for a decade during the follow-up. We segregated the sifted patients into two distinct cohorts: those who underwent cholecystectomy for gallstones (CG cohort) and those who received conservative treatment for gallstones (CTG cohort). Additionally, we randomly sampled a blank control cohort consisting of individuals who were neither diagnosed with gallstones nor underwent cholecystectomy from the database (Control cohort). We extensively examined the unadjusted incidence rates, standardized incidence rates (SIR), and relative hazard ratios (HR) of major gastrointestinal tumors. To minimize potential bias, we employed propensity score matching (PSM).
Results
The Control cohort consisted of a total of 171,301 individuals, while the CG and CTG groups comprised 89,879 and 54,838 individuals, respectively. The CG group exhibited a significantly higher incidence of colon cancer (0.23%), stomach cancer (0.20%), bile duct cancer (0.07%), and liver cancer (0.17%) compared to the Control group. The HR for bile duct cancer was particularly noteworthy, with a value of 2.54 (95% CI [1.59, 4.08]), while the HR for liver cancer was 1.35 (95% CI [1.06, 1.72]). However, compared to the CTG group, the standardized incidence rates of each tumor type in the CG group were significantly lower and decreased with longer follow-up time. The hazard ratios (HRs) for each cancer in the CG group were all less than 1.00 (with all p-values < 0.05).
Conclusions
Cholecystectomy is an effective option for reducing the risk of gastrointestinal tumors arising from gallstones. While it may not completely eliminate the risk of bile duct and liver cancers associated with gallstones, it still should be considered as a valuable option in managing the condition.