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  • 1. Aims and Scope

    Gut and Liver is an international journal of gastroenterology, focusing on the gastrointestinal tract, liver, biliary tree, pancreas, motility, and neurogastroenterology. Gut atnd Liver delivers up-to-date, authoritative papers on both clinical and research-based topics in gastroenterology. The Journal publishes original articles, case reports, brief communications, letters to the editor and invited review articles in the field of gastroenterology. The Journal is operated by internationally renowned editorial boards and designed to provide a global opportunity to promote academic developments in the field of gastroenterology and hepatology. +MORE

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    Editor-in-Chief
    Yong Chan Lee Professor of Medicine
    Director, Gastrointestinal Research Laboratory
    Veterans Affairs Medical Center, Univ. California San Francisco
    San Francisco, USA

    Deputy Editor

    Deputy Editor
    Jong Pil Im Seoul National University College of Medicine, Seoul, Korea
    Robert S. Bresalier University of Texas M. D. Anderson Cancer Center, Houston, USA
    Steven H. Itzkowitz Mount Sinai Medical Center, NY, USA
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    All papers submitted to Gut and Liver are reviewed by the editorial team before being sent out for an external peer review to rule out papers that have low priority, insufficient originality, scientific flaws, or the absence of a message of importance to the readers of the Journal. A decision about these papers will usually be made within two or three weeks.
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Increased Risk of Cancer after Cholecystectomy

Shih-Wei Lai1,2

1Department of Public Health, College of Public Health, and College of Medicine, China Medical University, and 2Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan

Correspondence to: Shih-Wei Lai
ORCID https://orcid.org/0000-0002-7420-1572
E-mail wei@mail.cmuh.org.tw

Received: May 19, 2022; Accepted: May 30, 2022

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Gut Liver.

Published online November 1, 2022

Copyright © Gut and Liver.

To the Editor:

One cohort study in South Korea conducted by Choi et al.1 revealed that the cancer risk was increased in people who underwent cholecystectomy than the aged- and sex-matched control group (adjusted hazard ratio=1.19). Some points not mentioned in the original article are discussed.

First, gallstone disease is the leading cause of cholecystectomy.2 Thus, we assume the cholecystectomized group found in the study of Choi et al.1 study should be those people with gallstone initially. The control group consisted of non-cholecystectomized people including those with gallstone and those without gallstone. The literature revealed that gallstone itself, not cholecystectomy, correlates with an increased risk of cancer.3 The readers hope to know the sub-analysis investigating: (1) the cancer risk between cholecystectomized people and non-cholecystectomized people having gallstone; (2) the cancer risk between cholecystectomized people and non-cholecystectomized people who did not have gallstone; and (3) the cancer risk between non-cholecystectomized people having gallstone and non-cholecystectomized people who did not have gallstone (Fig. 1). Then the role of cholecystectomy and gallstone on the risk of cancer might be clarified. Choi et al.1 commented that the operational definition of gallstone based on the claimed data was not accurate, so they did not analyze the relationship between carrying gallstone and cancer. We think that given the good quality of the Korean National Health Insurance Service database, the diagnosis of gallstone based on ICD-10 codes can be trusted. Choi et al.1 have the ability to conduct the sub-analysis to clarify the puzzle. In the absence of such a sub-analysis, it is difficult to persuade the readers that cholecystectomy itself would increase the cancer risk. The readers would believe that the increased cancer risk related to cholecystectomy is distorted by selection of an inappropriate control group. Second, surveillance bias should be considered. Persons of interest could be more closely monitored than the general population.4 Therefore, disease of interest may be early found in these monitored persons. Choi et al.1 also commented that cholecystectomized people might receive more health screening than non-cholecystectomized people. Thus cholecystectomized people had more chances to discover cancer. However, surveillance bias is difficult to avoid in observational studies clinically.5 Finally, we agree with Choi et al.1’s conclusion that further studies are warranted to clarify this issue.

Figure 1.The sub-analysis investigates: (1) the cancer risk between cholecystectomized people and non-cholecystectomized people having gallstone, (2) the cancer risk between cholecystectomized people and non-cholecystectomized people who did not have gallstone, and (3) the cancer risk between non-cholecystectomized people having gallstone and non-cholecystectomized people who did not have gallstone.

No potential conflict of interest relevant to this article was reported.

  1. Choi YJ, Jin EH, Lim JH, et al. Increased risk of cancer after cholecystectomy: a nationwide cohort study in Korea including 123,295 patients. Gut Liver 2022;16:465-473.
    Pubmed KoreaMed CrossRef
  2. Ansaloni L, Pisano M, Coccolini F, et al. 2016 WSES guidelines on acute calculous cholecystitis. World J Emerg Surg 2016;11:25.
    Pubmed KoreaMed CrossRef
  3. Shabanzadeh DM, Sørensen LT, Jørgensen T. Association between screen-detected gallstone disease and cancer in a cohort study. Gastroenterology 2017;152:1965-1974.
    Pubmed CrossRef
  4. Haut ER, Pronovost PJ. Surveillance bias in outcomes reporting. JAMA 2011;305:2462-2463.
    Pubmed CrossRef
  5. Hemminki K, Hemminki O, Försti A, Sundquist K, Sundquist J, Li X. Surveillance bias in cancer risk after unrelated medical conditions: example urolithiasis. Sci Rep 2017;7:8073.
    Pubmed KoreaMed CrossRef

Article

ahead

Gut and Liver

Published online November 1, 2022

Copyright © Gut and Liver.

Increased Risk of Cancer after Cholecystectomy

Shih-Wei Lai1,2

1Department of Public Health, College of Public Health, and College of Medicine, China Medical University, and 2Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan

Correspondence to:Shih-Wei Lai
ORCID https://orcid.org/0000-0002-7420-1572
E-mail wei@mail.cmuh.org.tw

Received: May 19, 2022; Accepted: May 30, 2022

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Body

To the Editor:

One cohort study in South Korea conducted by Choi et al.1 revealed that the cancer risk was increased in people who underwent cholecystectomy than the aged- and sex-matched control group (adjusted hazard ratio=1.19). Some points not mentioned in the original article are discussed.

First, gallstone disease is the leading cause of cholecystectomy.2 Thus, we assume the cholecystectomized group found in the study of Choi et al.1 study should be those people with gallstone initially. The control group consisted of non-cholecystectomized people including those with gallstone and those without gallstone. The literature revealed that gallstone itself, not cholecystectomy, correlates with an increased risk of cancer.3 The readers hope to know the sub-analysis investigating: (1) the cancer risk between cholecystectomized people and non-cholecystectomized people having gallstone; (2) the cancer risk between cholecystectomized people and non-cholecystectomized people who did not have gallstone; and (3) the cancer risk between non-cholecystectomized people having gallstone and non-cholecystectomized people who did not have gallstone (Fig. 1). Then the role of cholecystectomy and gallstone on the risk of cancer might be clarified. Choi et al.1 commented that the operational definition of gallstone based on the claimed data was not accurate, so they did not analyze the relationship between carrying gallstone and cancer. We think that given the good quality of the Korean National Health Insurance Service database, the diagnosis of gallstone based on ICD-10 codes can be trusted. Choi et al.1 have the ability to conduct the sub-analysis to clarify the puzzle. In the absence of such a sub-analysis, it is difficult to persuade the readers that cholecystectomy itself would increase the cancer risk. The readers would believe that the increased cancer risk related to cholecystectomy is distorted by selection of an inappropriate control group. Second, surveillance bias should be considered. Persons of interest could be more closely monitored than the general population.4 Therefore, disease of interest may be early found in these monitored persons. Choi et al.1 also commented that cholecystectomized people might receive more health screening than non-cholecystectomized people. Thus cholecystectomized people had more chances to discover cancer. However, surveillance bias is difficult to avoid in observational studies clinically.5 Finally, we agree with Choi et al.1’s conclusion that further studies are warranted to clarify this issue.

Figure 1. The sub-analysis investigates: (1) the cancer risk between cholecystectomized people and non-cholecystectomized people having gallstone, (2) the cancer risk between cholecystectomized people and non-cholecystectomized people who did not have gallstone, and (3) the cancer risk between non-cholecystectomized people having gallstone and non-cholecystectomized people who did not have gallstone.

CONFLICTS OF INTEREST

No potential conflict of interest relevant to this article was reported.

Fig 1.

Figure 1.The sub-analysis investigates: (1) the cancer risk between cholecystectomized people and non-cholecystectomized people having gallstone, (2) the cancer risk between cholecystectomized people and non-cholecystectomized people who did not have gallstone, and (3) the cancer risk between non-cholecystectomized people having gallstone and non-cholecystectomized people who did not have gallstone.
Gut and Liver 2022; :

References

  1. Choi YJ, Jin EH, Lim JH, et al. Increased risk of cancer after cholecystectomy: a nationwide cohort study in Korea including 123,295 patients. Gut Liver 2022;16:465-473.
    Pubmed KoreaMed CrossRef
  2. Ansaloni L, Pisano M, Coccolini F, et al. 2016 WSES guidelines on acute calculous cholecystitis. World J Emerg Surg 2016;11:25.
    Pubmed KoreaMed CrossRef
  3. Shabanzadeh DM, Sørensen LT, Jørgensen T. Association between screen-detected gallstone disease and cancer in a cohort study. Gastroenterology 2017;152:1965-1974.
    Pubmed CrossRef
  4. Haut ER, Pronovost PJ. Surveillance bias in outcomes reporting. JAMA 2011;305:2462-2463.
    Pubmed CrossRef
  5. Hemminki K, Hemminki O, Försti A, Sundquist K, Sundquist J, Li X. Surveillance bias in cancer risk after unrelated medical conditions: example urolithiasis. Sci Rep 2017;7:8073.
    Pubmed KoreaMed CrossRef
Gut and Liver

Vol.16 No.6
November, 2022

pISSN 1976-2283
eISSN 2005-1212

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