Wang Chi-Chih, Huang Jing-Yang, Weng Li-Han, Hsu Yao-Chun, Sung Wen-Wei, Huang Chao-Yen, Lin Chun-Che, Wei James Cheng-Chung, Tsai Ming-Chang
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung City 40201, Taiwan.
Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan.
Cancers (Basel). 2024 Feb 28;16(5):977. doi: 10.3390/cancers16050977.
(1) Background: Previous studies have raised concerns about a potential increase in pancreaticobiliary cancer risk after cholecystectomy, but few studies have focused on patients who undergo cholecystectomy after receiving endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis. This study aims to clarify cancer risks in these patients, who usually require cholecystectomy, to reduce recurrent biliary events. (2) Methods: We conducted a nationwide cohort study linked to the National Health Insurance Research Database, the Cancer Registry Database, and the Death Registry Records to evaluate the risk of pancreaticobiliary cancers. All patients who underwent first-time therapeutic ERCP for choledocholithiasis from 2011 to 2017 in Taiwan were included. We collected the data of 13,413 patients who received cholecystectomy after endoscopic retrograde cholangiopancreatography and used propensity score matching to obtain the data of 13,330 patients in both the cholecystectomy and non-cholecystectomy groups with similar age, gender, and known pancreaticobiliary cancer risk factors. Pancreaticobiliary cancer incidences were further compared. (3) Results: In the cholecystectomy group, 60 patients had cholangiocarcinoma, 61 patients had pancreatic cancer, and 15 patients had ampullary cancer. In the non-cholecystectomy group, 168 cases had cholangiocarcinoma, 101 patients had pancreatic cancer, and 49 patients had ampullary cancer. The incidence rates of cholangiocarcinoma, pancreatic cancer, and ampullary cancer were 1.19, 1.21, and 0.3 per 1000 person-years in the cholecystectomy group, all significantly lower than 3.52 ( < 0.0001), 2.11 ( = 0.0007), and 1.02 ( < 0.0001) per 1000 person-years, respectively, in the non-cholecystectomy group. (4) Conclusions: In patients receiving ERCP for choledocholithiasis, cholecystectomy is associated with a significantly lower risk of developing pancreaticobiliary cancer.
（1）背景：既往研究对胆囊切除术后胰胆管癌风险可能增加表示担忧，但很少有研究关注因胆总管结石接受内镜逆行胰胆管造影（ERCP）后再行胆囊切除术的患者。本研究旨在明确这些通常需要行胆囊切除术以减少复发性胆道事件的患者的癌症风险。（2）方法：我们进行了一项全国性队列研究，该研究与国民健康保险研究数据库、癌症登记数据库及死亡登记记录相关联，以评估胰胆管癌风险。纳入2011年至2017年在台湾首次因胆总管结石接受治疗性ERCP的所有患者。我们收集了13413例在内镜逆行胰胆管造影后接受胆囊切除术患者的数据，并使用倾向评分匹配法获取了胆囊切除组和非胆囊切除组中年龄、性别及已知胰胆管癌风险因素相似的13330例患者的数据。进一步比较胰胆管癌发病率。（3）结果：胆囊切除组中，60例患胆管癌，61例患胰腺癌，15例患壶腹癌。非胆囊切除组中，168例患胆管癌，101例患胰腺癌，49例患壶腹癌。胆囊切除组胆管癌、胰腺癌和壶腹癌的发病率分别为每1000人年1.19、1.21和0.3，均显著低于非胆囊切除组的每1000人年分别为3.52（<0.0001）、2.11（=0.0007）和1.02（<0.0001）。（4）结论：在因胆总管结石接受ERCP的患者中，胆囊切除术与发生胰胆管癌的风险显著降低相关。
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