Gallstones, cholecystectomy and risk of cancers of the liver, biliary tract and pancreas

To examine the association between gallstones and cholecystectomy, we condu cted a nationwide population-based cohort study in Denmark. Patients with a discharge diagnosis of gallstones from 1977 to 1989 were identified from t he Danish National Registry of Patients and followed up for cancer occurren ce until death or the end of 1993 by record linkage to the Danish Cancer Re gistry, included in the cohort were 60 176 patients, with 471 450 person-ye ars of follow-up. Cancer risks were estimated by standardized incidence rat ios (SIRs) and 95% confidence intervals (Cis) stratified by years of follow -up and by cholecystectomy status. Among patients without cholecystectomy, the risks at 5 or more years of follow-up were significantly elevated for c ancers of liver (SIR = 2.0, CI = 1.2-3.1) and gallbladder (SIR = 2.7, CI = 1.5-4.4) and near unity for cancers of extrahepatic bile duct (SIR = 1.1), ampulla of Vater (SIR = 1.0) and pancreas (SIR = 1.1). The excess risk of l iver cancer was seen only among patients with a history of hepatic disease. Among cholecystectomy patients, the risks at 5 or more years of follow-up declined for cancers of liver (SIR = 1.1) and extrahepatic bile duct (SIR = 0.7), but were elevated for cancers of ampulla of Vater (SIR = 2.0, CI = 1 .0-3.7) and pancreas (SIR = 1.3, CI = 1.1-1.6). These findings confirm that gallstone disease increases the risk of gallbladder cancer, whereas cholec ystectomy appears to increase the risk of cancers of ampulla of Vater and p ancreas. Further research is needed to clarify the carcinogenic risks assoc iated with gallstones and cholecystectomy and to define the mechanisms invo lved.