title: Incidence of cancer of the pancreas, extrahepatic bile duct and ampulla of Vater in the United States, before and after the introduction of laparoscopic cholecystectomy.
abstract: BACKGROUND
  Some epidemiologic studies have identified cholecystectomy as a risk factor for pancreatic and biliary cancer.
  
  
  METHODS
  We compared the incidence of cancers of the pancreas, extrahepatic bile duct and ampulla of Vater before and after the widespread adoption of laparoscopic cholecystectomy in the United States in 1991, when the use of cholecystectomy increased dramatically.
  
  
  RESULTS
  Compared with 1980 to 1991, there was no increase in the incidence of cancer of the pancreas (adjusted incidence rate ratio [IRR] 0.97, 95% confidence interval [CI] 0.94 to 0.99) or extrahepatic bile duct (IRR 0.80, 95% CI 0.74 to 0.87) during 1992 to 1996. There was a small increase in the incidence of ampullary cancer (IRR 1.14, 95% CI 1.03 to 1.26).
  
  
  CONCLUSIONS
  We did not find clear evidence of a short-term increase in the incidence of cancers of the pancreas, bile duct, and ampulla of Vater, that was attributable to the increased use of cholecystectomy.
authors.affiliation: Department of Minimally Invasive Surgery and Surgical Research, Legacy Health System, Portland, Oregon, USA. david.urbach@uhn.on.ca
authors.forename: D R
authors.initials: DR
authors.lastname: Urbach
authors.forename: L L
authors.initials: LL
authors.lastname: Swanstrom
authors.forename: Y S
authors.initials: YS
authors.lastname: Khajanchee
authors.forename: P D
authors.initials: PD
authors.lastname: Hansen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater; D001650:Bile Duct Neoplasms / Q000453:epidemiology* / Q000209:etiology; D017734:Bile Ducts, Extrahepatic; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D003138:Common Bile Duct Neoplasms / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010190:Pancreatic Neoplasms / Q000453:epidemiology* / Q000209:etiology; D016012:Poisson Distribution; D012044:Regression Analysis; D012306:Risk; D014481:United States / Q000453:epidemiology