Copyright
©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Cholecystectomy reduces subsequent cholangiocarcinoma risk in choledocholithiasis patients undergoing endoscopic intervention
Chi-Chih Wang, Ming-Hseng Tseng, Sheng-Wen Wu, Tzu-Wei Yang, Hsuan-Yi Chen, Wen-Wei Sung, Chang-Cheng Su, Yao-Tung Wang, Chun-Che Lin, Ming-Chang Tsai
Chi-Chih Wang, Tzu-Wei Yang, Hsuan-Yi Chen, Chang-Cheng Su, Ming-Chang Tsai, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, and Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
Ming-Hseng Tseng, Department of Medical Informatics, Chung Shan Medical University, Taichung 402, Taiwan
Sheng-Wen Wu, Department of Internal Medicine, Chung Shan Medical University Hospital and School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
Wen-Wei Sung, Department of Urology, Chung Shan Medical University Hospital, and Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
Yao-Tung Wang, Division of Pulmonary Medicine, Chung Shan Medical University Hospital, and Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
Chun-Che Lin, Department of Internal Medicine, China Medical University Hospital and School of Medicine, China Medical University, Taichung 402, Taiwan
Author contributions: Wang CC and Tsai MC contributed to study conception and design; Tseng MH and Wu SW contributed to acquisition of the data; Wang CC, Wang YT, and Wu SW contributed to analysis and interpretation of the data; Wang CC, Yang TW, and Chen HY contributed to drafting of the manuscript; Tsai MC, Yang TW, Sung WW, and Lin CC contributed to critical revision of the manuscript; Tseng MH, Tsai MC, and Su CC contributed to statistical analysis; Tsai MC contributed to supervision.
Supported by Chung Shan Medical University Hospital Research program, No. CSH-2013-C-032.
Institutional review board statement: This study was approved by the Institutional Review Board (IRB) of Chung Shan Medical University Hospital, Taiwan. All methods were performed in accordance with the relevant guidelines and regulations and under surveillance by the IRB of Chung Shan Medical University Hospital.
Conflict-of-interest statement: Chun-Che Lin has received research funding from Chung Shan Medical University Hospital Research program (CSH- 2013-C-032) for national health insurance data collection.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Ming-Chang Tsai, MD, PhD, Assistant Professor, Doctor, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, No. 110, Sec. 1, Jianguo N. Road, South District, Taichung 402, Taiwan. tsaimc1110@gmail.com
Received: July 4, 2020
Peer-review started: July 4, 2020
First decision: September 18, 2020
Revised: September 26, 2020
Accepted: October 30, 2020
Article in press: October 30, 2020
Published online: December 15, 2020
BACKGROUND
Cholangiocarcinoma is a disease with a high mortality rate. Our previous study revealed that cholelithiasis patients who undergo endoscopic sphincterotomy (ES)/endoscopic papillary balloon dilatation are at a higher risk for subsequent cholangiocarcinoma than cholelithiasis patients who undergo cholecystectomy.
AIM
To clarify the relationship between recurrent biliary events and subsequent cholangiocarcinoma risk in choledocholithiasis patients.
METHODS
From one million random cases in the Taiwan National Health Insurance Research Database 2004–2011, we selected symptomatic choledocholithiasis patients older than 18 years who were admitted from January 2005 to December 2009 (study group). Cases for a control group were defined as individuals who had never been diagnosed with cholelithiasis, matched by sex and age in a 1:3 ratio. The study group was further divided into ES/endoscopic papillary balloon dilatation, both ES/endoscopic papillary balloon dilatation and cholecystectomy, and no intervention groups.
RESULTS
We included 2096 choledocholithiasis patients without previous intervention or cholangiocarcinoma. A total of 12 (2.35%), 11 (0.74%), and 1 (1.00%) subsequent cholangiocarcinoma cases were diagnosed among 511 ES/endoscopic papillary balloon dilatation patients, 1485 patients with no intervention, and 100 ES/endoscopic papillary balloon dilatation and cholecystectomy patients, respectively. The incidence rates of recurrent biliary event were 527.79/1000 person-years and 286.69/1000 person-years in the subsequent cholangiocarcinoma and no cholangiocarcinoma group, showing a high correlation between subsequent cholangiocarcinoma risk and recurrent biliary events.
CONCLUSION
Choledocholithiasis patients who undergo further cholecystectomy after ES/endoscopic papillary balloon dilatation have decreased subsequent cholangiocarcinoma risk due to reduced recurrent biliary events.
Core Tip: Choledocholithiasis patients who undergo further cholecystectomy after endoscopic sphincterotomy/endoscopic papillary balloon dilatation have a decreased subsequent cholangiocarcinoma risk. The relationship between the incidence of recurrent biliary events and that of subsequent cholangiocarcinoma is statistically meaningful.
