title: Cholecystectomy and the risk of alimentary tract cancers: a systematic review.
abstract: OBJECTIVE
  To investigate the association between cholecystectomy and gastro-intestinal tract (GIT) cancers.
  
  
  METHODS
  We conducted a systematic review according to the PRISMA guidelines. A MEDLINE search was performed with predefined search criteria for English Language articles on the association between cholecystectomy and GIT cancers. Additional articles were retrieved by manual search of references. All relevant articles were accessed in full text. Data on study type; cases; controls; country; effect estimate; adjustments for confounders and quality of publication were extracted. The quality of the publications were scored by adherence to the STROBE checklist. The data for each part of the GIT were presented in separate tables.
  
  
  RESULTS
  Seventy-five studies and 5 meta-analyses satisfied the predefined criteria for inclusion and were included in this review. There were inconsistent reports and no strong evidence of an association between cholecystectomy and cancers of the oesophagus (Adenocarcinoma), pancreas, small bowel and right-sided colon cancers. In squamous cancer of the oesophagus, cancers of the stomach, liver, bile ducts, small bowel and left sided colon cancers, good quality studies suggested a lack of association with cholecystectomy. Equally, distal colon and rectal cancers were found not to be associated with cholecystectomy. Several mechanisms for carcinogenesis/promotion of carcinogensis have been proposed. These have focused on a role for bile salts in carcinogenesis with several potential mutagenic molecular events and gut metabolic hormones signaling cell proliferation or initiation of carcinogenesis.
  
  
  CONCLUSIONS
  This is a comprehensive review of the association between GIT cancers and cholecystectomy. This review found no clear association between cholecystectomy and GIT cancers.
authors.affiliation: Maria Coats, Sami M Shimi, Department of Surgery, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, Scotland.
authors.forename: Maria
authors.initials: M
authors.lastname: Coats
authors.affiliation: Maria Coats, Sami M Shimi, Department of Surgery, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, Scotland.
authors.forename: Sami M
authors.initials: SM
authors.lastname: Shimi
mesh_terms: D002763:Cholecystectomy / Q000009:adverse effects*; D004067:Digestive System Neoplasms / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D016017:Odds Ratio; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Cancer; Carcinogenesis; Cholecystectomy; Gastro-intestinal tract
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