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Original Articles
- 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
- DOI: https://doi.org/10.3961/jpmph.18.105
- 7,854 View
- 220 Download
- 20 Crossref
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Abstract
Summary
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Supplementary Material - Objectives
We investigated the association between cholecystectomy or appendectomy and the subsequent risk of colorectal cancer (CRC) in the Korean population.
Methods
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.
Results
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.
Conclusions
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. -
SummaryKorean 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. -
Citations
Citations to this article as recorded by
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Journal of Pediatric Endoscopic Surgery.2019; 1(3): 119. CrossRef
- Beyond a vestigial organ: effects of the appendix on gut microbiome and colorectal cancer
- A Comparison of Laparoscopic Cholecystectomy with Open Cholecystectomy in a Korean Hospital.
- Eun Mee Lee, Seung Hum Yu, Myong Sei Sohn, Suk Il Kim
- Korean J Prev Med. 1995;28(2):325-333.
- 1,956 View
- 21 Download
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Abstract
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- Laparoscopic cholecystectomy was introduced into Korea in 1990 and has been rapidly replacing open cholecystectomy when the indications were met. In this study a medical utilization and technology was assessed on the selected hospitalized patients with cholelithiasis who underwent open or laparoscopic cholecystectomy from April 1, 1991 to March 31, 1994. The results are as follows. Despite the low reimbursement rate by the health insurance, the number of laparoscopic cases have been steadily increased. The post-operative days before health insurance coverage were significantly shortened from 8.4 days to 4.6 days. The preoperative days before health insurance coverage were significantly shorted from 8.4 days to 4.0 days. The total length-of-stays in the hospital were also significantly shortened from 15.2 days to 10.7 and 9.8 days in laparoscopic cholecystectomy. The laparoscopic cholecystectomy showed low expenses in all aspects expect the average hospital charges per day. For the hospital to have cost containment, it is more effective if length-of-stay is shorter because of high daily inpatient hospital charge. The laparoscopic cholecystectomy also showed shortened anesthesia time and operation time compared with open cholecystectomy that were statistically significant. The mean anesthesia and operation time for open cholecystectomy were 113.2 and 90.2 minutes but those of laparoscopic cholecystectomy were 105.7 and 68.6 minutes. According to this study the laparoscopic cholecystectomy has reduced the medical expenditure and we recommend this procedure over open cholecystectomy. The further discussion on the different morbidity rate between two types of procedure is essential in providing quality medical care, and to educate specialist.
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Summary
- An Appropriateness Evaluation of Cesarean Section, Cholecystectomy, and Admission in Pediatric Pneumonia.
- Chang Yup Kim, Hyeong Sik Ahn, Young Seong Lee, Young Dae Kwon, Yong Ik Kim, Young Soo Shin
- Korean J Prev Med. 1992;25(4):413-428.
- 1,946 View
- 19 Download
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Abstract
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- The aim of this study was to evaluate the appropriateness of some kinds of surgery and admission, such as cesarean section (C/S), cholecystectomy, and pediatric pneumonia. For appropriateness evaluation, we ourselves developed some criteria, which were included in the category of explicit and linear criteria, with the assistance of specialists of relevant clinical field. The evaluation of appropriateness was performed by two family physicians. The major findings were as follows: 1. For ceserean section, 77.6% of deliveries were determined to be 'appropriate', but the level of appropriateness was not significantly different among hospitals between hospital groups by size. The most frequent indication of C/S was repeated operation, followed by cephalopelvic disproportion(CPD). The labor trials for vaginal delivery among repeated C/S and CPD cases were performed in 24.5% of pertinent deliveries. 2. About 73.8% of cholecystectomy cases was appropriate to one of the surgical indications, without significant differences among hospitals. Of surgical indications, 'sufficiently frequent and intense symptom recurrence' was the most frequent, and 'confirmed acute cholecystitis' was the second. 3. Of children admitted due to pneumonia, only 57.4% of cases satisfied admission criteria, and the level of appropriateness of admission was different among hospitals. The common reasons for admission were 'failure to initial treatment', 'suspected bacterial pnermonia', 'young infant', etc. We could find that there were differences of quality among hospitals in some procedures, especially in the pediatric pneumonia and labor trial before C/S, which suggested that the implementation of quality assurance activities would be necessary in this country. In this study, we used some simple and primitive research tools and the numbers of subjects and tracer procedures were limited. So advanced studies with plentiful subjects and more representative diseases or procedures should be tried.
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