The Relationship Between Cholecystectomy And Colorectal Cancer

Objective:Application of propensity score matching(PSM).The data of cholecystectomy in patients with colorectal cancer confirmed by pathology in Affiliated Dalian Friendship Hospital of Dalian Medical University and the first affiliated hospital to Dalian Medical University,as well as in patients with colorectal cancer and colorectal polyp excluded by colonoscopy at the same time,were analyzed 10 years ago to determine whether cholecystectomy can lead to high incidence of colorectal cancer and provide reference for clinical decision-makingMaterials and Methods:From January 1,2017 to September 31,2019,1056 colorectal cancer patients(observation group)with complete case data in Affiliated Dalian Friendship Hospital of Dalian Medical University and the first affiliated hospital to Dalian Medical University,and 654 colorectal cancer and polyp patients(control group)with the exception of colonoscopy in the same period were selected,and the data were consistent with the selection According to the clinical data of standard patients,the specific time,BMI(body weight and height calculated by thermometer),the history of type 2 diabetes,the history of essential hypertension,smoking and drinking were recorded from the previous cholecystectomy to the discovery of colorectal cancer.BMI standard refers to the standard of China adult overweight and obesity prevention guide issued by the Ministry of health.BMI?24.0kg/m2 is regarded as overweight,which is divided into super recombination and non super recombination.The collected body weight and height is the data measured for the first time when the patient was admitted to hospital.The age,gender,BMI(BMI?24kg/m2,i.e.hyper recombination,and non hyper recombination<24kg/m2),type 2 diabetes mellitus,essential hypertension,smoking and drinking were matched by propensity score matching method.SPSS 22.0 software was used for data statistical analysis,in which the measurement data of normal distribution was expressed in x±s,the independent sample t test was used for inter group comparison,the Mann Whitney U test was used for inter group comparison of skew distribution,and the measurement data was expressed in M(P25,P75).The counting data were expressed by rate and counting ratio,and the differences between groups were compared by ?2 test and Fisher's exact test.SPSS was used The PSM extended function of 22.0 realizes PSM analysis,taking whether there was a history of cholecystectomy 10 years ago as the corresponding variable,each covariate as the independent variable,the propensity score value is estimated by logistic regression,and 1:1 nearest neighbor matching method is used to match each control group individual with an observation group individual with the most similar propensity score value,which is guaranteed by defining the optimal caliper value Then,we compare the standard differences of covariates between groups before and after matching.The data of final analysis showed that P<0.05(bilateral)was statistically significant,and the relationship between cholecystectomy and colorectal cancer after matching was analyzed.Results:1,056 cases were enrolled in the observation group and 654 cases were enrolled in the control group.There were differences in age,gender,type 2 diabetes,essential hypertension,smoking,and drinking in the two groups of patients before matching,and the indicators were uneven(P<0.05).The absolute value of the standard deviation of each index was between 0.031%and 9.252%,of which the maximum absolute value of the standard deviation of the age of the two groups of patients was 9.252%,and the absolute standard deviation of the essential hypertension was 0.031%.The propensity score matching method was adopted,1:1 nearest neighbor matching was used,and the caliper value was selected to be 0.01.The control group was used as the reference group for matching.There were 442 successful matches in the two groups.The covariates of type 2 diabetes,essential hypertension,smoking,and alcohol reached equilibrium(P>0.05).By matching the two groups,the standard deviations were less than 10%,and the standardized differences were between 0.002%and 0.052%.Between them,the balance of the covariates has been improved and improved to different degrees through the tendency score matching method,and the two groups are comparable.There were 15 cases of cholecystectomy in the observation group after matching,accounting for 3.4%of the cases in the observation group after matching,including 3 males and 12 women,and 10 cases in the control group,accounting for 2.3%of the control group,including 6 males.Cases,4 women.Analysis by 2 × 2 chi-square test showed that there was no correlation between cholecystectomy and colorectal cancer(?2?1.029,P=0.310,OR=1.257,95%CI 0.774-2.041),indicating that cholecystectomy and colorectal cancer occurred There was no significant correlation,that is,cholecystectomy was not related to the occurrence of colorectal cancer.The matched data were classified according to the location of colorectal cancer.There were 63 cases of right colon cancer in the observation group,6 cases of previous cholecystectomy,and 1 case of control group who had previously performed cholecystectomy.The 2 X 2 chi-square test showed that there was no correlation between cholecystectomy and the occurrence of right colon cancer(?2=3.782,P=0.052,OR=3.647,95%CI 0.589-22.571);a total of 109 patients with sigmoid colon cancer in the observation group Among them,there were 3 cases of previous cholecystectomy,and 2 cases of previous cholecystectomy in the control group.After 2×2 chi-square test,the results showed that there was no correlation between cholecystectomy and sigmoid colon cancer(?2=0.205,P=0.651,OR=1.256,95%CI 0.426-3.705);220 cases of rectal cancer in the observation group,of which 6 cases had previous cholecystectomy,and 7 cases in the control group had previous cholecystectomy.After 2 X 2 chi-square test,the results showed that there was no correlation between cholecystectomy and rectal cancer(?2=0.079,P=0.778,OR=0.926,95%CI 0.555-1.546).Analysis of the above sub-sites shows that cholecystectomy does not lead to a high incidence of tumors in one part of the colorectum.Conclusion:Based on the propensity score matching method,all possible confounding factors that affect the development of colorectal cancer have been eliminated.Through long-term observation,our research results show that cholecystectomy cannot lead to a high incidence of colorectal cancer,not a high risk of colorectal cancer factor.Further analysis showed that cholecystectomy did not cause a high incidence of tumors in one part of the colorectum.Therefore,for patients with gallbladder stones and cholecystitis that have clinical indications for surgery,patients with gallbladder polyps should dispel concerns that they may cause colorectal cancer after resection,adopt an active surgical strategy,and remove the gallbladder as soon as possible to avoid recurrence of cholecystitis in the future.Consequences of secondary common bile duct stones,biliary pancreatitis,and even gallbladder cancer.