Cholecystectomy can increase the risk of colorectal cancer: A meta-analysis of 10 cohort studies - PubMed (original) (raw)

Meta-Analysis

. 2017 Aug 3;12(8):e0181852.

doi: 10.1371/journal.pone.0181852. eCollection 2017.

Hao Liu 1, Li Li 1, Min Ai 2, Zheng Gong 1, Yong He 1, Yunlong Dong 1, Shuanglan Xu 3, Jun Wang 1, Bo Jin 1, Jianping Liu 4, Zhaowei Teng 5

Affiliations

Meta-Analysis

Cholecystectomy can increase the risk of colorectal cancer: A meta-analysis of 10 cohort studies

Yong Zhang et al. PLoS One. 2017.

Erratum in

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Abstract

Objective: This study aimed to elucidate the effects of cholecystectomy on the risk of colorectal cancer (CRC) by conducting a meta-analysis of 10 cohort studies.

Methods: The eligible cohort studies were selected by searching the PubMed and EMBASE databases from their origination to June 30, 2016, as well as by consulting the reference lists of the selected articles. Two authors individually collected the data from the 10 papers. When the data showed marked heterogeneity, we used a random-effects model to estimate the overall pooled risk; otherwise, a fixed effects model was employed.

Results: The final analysis included ten cohort studies. According to the Newcastle-Ottawa Scale (NOS), nine papers were considered high quality. After the data of these 9 studies were combined, an increased risk of CRC was found among the individuals who had undergone cholecystectomy (risk ratio (RR) 1.22; 95% confidence interval (CI) 1.08-1.38). In addition, we also found a promising increased risk for colon cancer (CC) (RR 1.30, 95% CI 1.07-1.58), but no relationship between cholecystectomy and rectum cancer (RC) (RR 1.09; 95% CI 0.89-1.34) was observed. Additionally, in the sub-group analysis of the tumor location in the colon, a positive risk for ascending colon cancer (ACC) was found (RR 1.18, 95% CI 1.11-1.26). After combining the ACC, transverse colon cancer (TCC), sigmoid colon cancer (SCC) and descending colon cancer (DCC) patients, we found a positive relationship with cholecystectomy (RR 1.18, 95% CI 1.11-1.26). Furthermore, after combining the ACC and DCC patients, we also found a positive relationship with cholecystectomy (RR 1.28; 95% CI 1.11-1.26) in the sub-group analysis. In an additional sub-group analysis of patients from Western countries, there was a positive relationship between cholecystectomy and the risk of CRC (RR 1.20; 95% CI 1.05-1.36). Furthermore, a positive relationship between female gender and CRC was also found (RR 1.17; 95% CI 1.03-1.34). However, there was no relationship between gender and CC or RC. Furthermore, no publication bias was observed, and the sensitivity analysis indicated stable results.

Conclusions: This meta-analysis of 10 cohort studies revealed that cholecystectomy is associated with an increased risk for CRC, CC and ACC, particularly in Western countries. No relationship between cholecystectomy and RC was observed. There was no relationship between gender and either CC or RC, but a positive relationship between female gender and CRC was observed.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1

Fig 1. Flow chart illustrating the literature search for cohort studies on cholecystectomy in relation to CRC.

Note: CRC represents colorectal cancer.

Fig 2

Fig 2. Forest plot of risk of CRC associated with cholecystectomy in general population.

Note: CRC represents colorectal cancer.

Fig 3

Fig 3. Forest plot of risk of CC associated with cholecystectomy in general population.

Note: CC represents colon cancer.

Fig 4

Fig 4. Forest plot of risk of RC associated with cholecystectomy in general population.

Note: RC represents rectum cancer.

Fig 5

Fig 5. Sensitivity analysis of the association between cholecystectomy and CRC risk in general population.

Note: CRC represents colorectal cancer.

Fig 6

Fig 6. Begg’s funnel plot of the 10 cohort studies.

Fig 7

Fig 7. Egger’s publication bias plot of the 13 cohort studies.

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