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Family Practice Vol. 13, No. 5, 483-487
© Oxford University Press 1996

research-article

Selections from current literature: cholelithiasis, cholecystectomy and the risk of colorectal cancer

Mirza I Rahman, Lada D Gibson-Shreve, Zhong Yuan and Heidi A Morris

Departments of Family Practice, Epidemiology and Biostatistics, MetroHealth Medical Center, Case Western Reserve University 2500 MetroHealth Drive, Cleveland, OH 44109-1998, USA.

The study by Ekbom et al. clearly demonstrates that, overall, there is no increased risk of colorectal cancer following cholecystectomy. However, it is noted that women have a slight increase in the risk of proximal colon cancer following cholecystectomy. The reasons for this finding remain unclear. However, since this finding has been consistent in several studies, it is prob ably not an artifact, but a true association that may warrant further investigation.

It is possible that the association noted between cholecystectomy and colorectal cancer is due not to the cholecystectomy, but to the reason why cholecystec tomies are performed, namely the presence of gall stones. The cholecystectomy itself may simply be a surrogate for cholelithiasis, which may be a true risk factor for colorectal cancer. Excess secondaxy bile acids may be carcinogenic or the factors which cause the formation of cholelithiasis may also increase the risk for developing colorectal cancer.

An answer to the separate question of whether ex cessive laparoscopic cholecystectomies are being performed, or whether newer indications make the in creased number of laparoscopic cholecystectomies appropriate, remain outstanding. This new procedure, despite being cheaper than the open cholecystectomy, has resulted in greater utilization of the world's dwind ling health care resources.


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