Long-term risk of colorectal cancer following cholecystectomy: a nationwide cohort study.

BACKGROUND

Cholecystectomy (CCY) is one of the most commonly performed abdominal surgeries in the USA. However, limited population-level data are available that evaluate the long-term risk of colorectal cancer (CRC) following CCY. In this study, we aimed to assess the association between CCY and the risk of developing CRC.

METHODS

We conducted a retrospective cohort study using the TriNetX research network. We identified adult patients (≥ 18 years) with a history of CCY between 2010 and 2024. These patients were matched using propensity score matching with adult patients without a history of CCY. Matching was based on demographics, comorbidities, and CRC risk factors. The primary outcome was the risk of first diagnosis of CRC that occurred after the index event (cholecystectomy). Secondary outcomes assessed included colon cancer, rectal cancer, and subsite-specific cancers involving the right-sided, transverse, and descending/sigmoid colon. Subgroup analyses were performed by gender and age categories. With censoring applied, Kaplan-Meier analysis with adjusted hazard ratios (aHRs) and 95% CIs was used to compare time-to-event rates at daily time intervals.

RESULTS

A total of 613,396 patients with a history of CCY were matched 1:1 to controls (mean age 48.5 ± 18.1 years; 68.1% female; 71.2% White). CRC was more common in the CCY group (1.11 vs 0.61%; aHR 2.16, 95% CI 2.08-2.25; p < 0.001). CRC risk was elevated in both sexes, with a stronger association in males (aHR 2.57, 95% CI 2.41-2.73; p < 0.001) than females (aHR 1.93, 95% CI 1.83-2.04; p < 0.001). CRC risk following CCY was elevated across all age groups, with the highest overall CRC risk observed in patients aged 18-45 years (aHR 2.41, 95% CI 2.01-2.87), with a notably elevated risk for right-sided colon cancer (aHR 4.08, 95% CI 2.91-5.74).

DISCUSSION: Our study showed an association between CCY and increased CRC risk, especially right-sided colon cancer. This risk was higher in males and younger adults, but elevated across all age and sex subgroups.