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Seung-Yong Jeong 1 Article
The Risk of Colorectal Cancer After Cholecystectomy or Appendectomy: A Population-based Cohort Study in Korea
Joonki Lee, Sunho Choe, Ji Won Park, Seung-Yong Jeong, Aesun Shin
J Prev Med Public Health. 2018;51(6):281-288.   Published online October 29, 2018
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AbstractAbstract AbstractSummary PDFSupplementary Material
We investigated the association between cholecystectomy or appendectomy and the subsequent risk of colorectal cancer (CRC) in the Korean population.
A retrospective cohort study was conducted with the National Health Insurance Service–National Sample Cohort of Korea; this sample was followed up from January 1, 2002, until the date of CRC incidence, loss to follow-up, or December 31, 2015. The exposure status of cholecystectomy and appendectomy was treated as a time-varying covariate. The calculated risk of CRC was stratified by follow-up period, and the association between these surgical procedures and CRC was investigated by a Cox regression model applying appropriate lag periods.
A total of 707 663 individuals were identified for analysis. The study population was followed up for an average of 13.66 years, and 4324 CRC cases were identified. The hazard ratio (HR) of CRC was elevated in the first year after cholecystectomy (HR, 1.71; 95% confidence interval [CI], 1.01 to 2.89) and in the first year and 2-3 years after appendectomy (HR, 4.22; 95% CI, 2.87 to 6.20; HR, 2.34; 95% CI, 1.36 to 4.03, respectively). The HRs of CRC after applying 1 year of lag after cholecystectomy and 3 years of lag after appendectomy were 0.80 (95% CI, 0.57 to 1.13) and 0.77 (95% CI, 0.51 to 1.16), respectively.
The risk of CRC increased in the first year after cholecystectomy and appendectomy, implying the possibility of bias. When appropriate lag periods after surgery were applied, no association was found between cholecystectomy or appendectomy and CRC.
Korean summary
본 연구는 담낭절제술, 충수돌기절제술 후 대장암의 발생위험에 관한 연구로 국민건강보험공단 표본코호트자료를 사용한 후향적코호트 연구이다. 총 707 663명을 대상으로 연구를 진행하였으며, 담낭절제술을 시행한 환자들은 수술 후 1년 이내에서 대장암의 위험도가 유의하게 증가하였으나 이후 관련성을 보이지 않았고, 충수돌기절제술을 시행한 환자들은 수술 후 1년, 2~3년에서 유의하게 위험도가 증가하였으나, 이후에는 관련성을 보이지 않았다. 이 결과는 역인과관계의 가능성을 시사하며 이것을 고려하였을 때, 담낭절제술과 충수돌기절제술은 대장암의 발생위험과의 연관성을 보이지 않았다.


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JPMPH : Journal of Preventive Medicine and Public Health