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

Since 1978 when it was first reported that cholecystectomy may increase the risk of developing colorectal cancer, over 60 epidemiological studies have been published world-wide, evaluating whether in fact there is a causal association. The search for an answer to this intriguing question is not merely to satisfy the intellectual curiosity of the researchers involved in this work. Instead, it is of particular relevance to primary care physicians who often need to refer their patients for cholecystectomies. Colorectal cancer is the fourth most common type of cancer in the USA and the second leading cause of cancer mortality. In 1996 it is estimated that there will be 133 500 new cases, and 54 900 deaths, as a result of colorectal cancer in America. Among the industrialized countries of the world, the age-adjusted death rate from colorectal cancer is in excess of 15 per 100 000 population. There has been an increased performance of cholecystectomies now that laparoscopic cholecystectomy is available, easier to perform, and results in less morbidity. This increase in cholecystectomies could potentially lead to a debacle in the future, if in fact it truly leads to an increased risk of colorectal cancer. The percentage of cholecystectomies being performed laparoscopically rose from zero in 1987 to 80% in 1992 in America. This was due to the procedure having been evaluated as a safe and effective alternative to open cholecystectomy. In this Selections, the first two articles address the biological plausibility of the notion that cholelithiasis or a cholecystectomy may increase the risk of developing colorectal cancer. Then, three recent reports on the subject of cholecystectomy and colorectal cancer, each using a different epidemiological methodology, will be reviewed. Finally, the broader implications for widespread use of laparoscopic cholecystectomy in light of these findings will be discussed.