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

The study by Ekbom et al. clearly demonstrates that, overall, there is no increased risk of colorectal cancer following cholecystectomy. However, it is noted that women have a slight increase in the risk of proximal colon cancer following cholecystectomy. The reasons for this finding remain unclear. However, since this finding has been consistent in several studies, it is probably not an artifact, but a true association that may warrant further investigation. It is possible that the association noted between cholecystectomy and colorectal cancer is due not to the cholecystectomy, but to the reason why cholecystectomies are performed, namely the presence of gallstones. The cholecystectomy itself may simply be a surrogate for cholelithiasis, which may be a true risk factor for colorectal cancer. Excess secondary bile acids may be carcinogenic or the factors which cause the formation of cholelithiasis may also increase the risk for developing colorectal cancer. An answer to the separate question of whether excessive laparoscopic cholecystectomies are being performed, or whether newer indications make the increased number of laparoscopic cholecystectomies appropriate, remain outstanding. This new procedure, despite being cheaper than the open cholecystectomy, has resulted in greater utilization of the world's dwindling health care resources. In conclusion, the decision to perform a cholecystectomy should be made only with consideration of the patient's current medical condition. There is no need to be concerned about any future increased risk of colorectal cancer following a cholecystectomy.