Alimentary TractIntestinal cancer after cholecystectomy: Is bile involved in carcinogenesis?☆
Section snippets
Design
We conducted a nationwide, retrospective population-based cohort study in Sweden. The cohort consisted of patients who had undergone cholecystectomy between the 33-year-period 1965 through 1997. Cholecystectomized patients were identified through the nationwide Swedish Inpatient Register.
The Swedish Inpatient Register
From 1964–1965, the National Board of Health and Welfare established the Swedish Inpatient Register. Information about the National Registration Number, a unique 10-digit identification number assigned to all
The cohort
Some characteristics of the cohort members are presented in Table 1.Characteristics Men Women All Number of cholecystectomized patients 90,987 187,473 278,460 Mean age (and range) at cholecystectomy (yr) 56.8 (0–99) 49.9 (0–100) 52.2 (0–100) Mean follow-up duration after cholecystectomy (yr) 10.9 12.8 12.1 Range of follow-up after cholecystectomy (yr) 1–32 1–32 1–32 Number of person-years of follow-up 1,034,651 2,485,030 3,519,682
Discussion
In the present study, we could demonstrate an association between cholecystectomy and cancer of the small bowel and proximal colon, with a gradient and a decreasing risk with increasing distance from the common bile duct. A history of surgery on the common bile duct as part of the cholecystectomy enhanced the association between cholecystectomy and proximal small bowel cancer.
More than 60 epidemiologic studies have analyzed the association between cholecystectomy and the risk of colorectal
Acknowledgements
The authors thank Li Yin for skillful help with programming.
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Address requests for reprints to: Jesper Lagergren, M.D., Ph.D, Department of Surgery, Karolinska Hospital, SE-171 76 Stockholm, Sweden. e-mail: [email protected]; fax: (46) 8 33 15 87.