The risk of developing a mismatch repair deficient colorectal cancer after undergoing cholecystectomy

Abstract

Objectives: Mismatch repair deficient (dMMR) colorectal cancer (CRC) is caused by inactivation of the MMR DNA repair system, most commonly via epigenetic inactivation of the MLH1 gene, and these tumors occur most frequently in the right colon. The objective was to determine whether cholecystectomy (CCY) increases the risk of a dMMR CRC by comparing CCY incidence in patients with dMMR CRC and proficient MMR (pMMR) CRC to unaffected controls.

Materials and methods: All patients diagnosed with CRC in Iceland from 2000 to 2009 (n = 1171) were included. They had previously been screened for dMMR by immunohistochemistry (n = 129 were dMMR). Unaffected age- and sex-matched controls (n = 17,460) were obtained from large Icelandic cohort studies. Subjects were cross-referenced with all pathology databases in Iceland to establish who had undergone CCY. Odds ratios were calculated using unconditional logistic regression.

Results: Eighteen (13.7%) dMMR CRC cases and 90 (8.7%) pMMR CRC cases had undergone CCY compared to 1532 (8.8%) controls. CCY-related odds ratios (OR) were 1.06 (95% CI 0.90–1.26, p = .577) for all CRC, 1.16 (95% CI 0.66–2.05 p = .602) for dMMR CRCand 1.04 (95% CI 0.83–1.29, p = .744) for pMMR CRC. Furthermore, OR for dMMR CRC was 0.51 (95% CI 0.16–1.67, p = .266), 2.04 (95% CI 0.92–4.50, p = .080) and 1.08 (95% CI 0.40–2.89, p = .875) <10 years, 10–20 years and >20 years after a CCY, respectively.

Conclusions: There was no evidence of increased risk of developing dMMR CRC after CCY although a borderline significantly increased 2-fold risk was observed 10–20 years after CCY. Larger studies are warranted to examine this further.

Keywords:

• Microsatellite instability
• cholecystectomy
• colorectal cancer risk factors
• carcinogenesis of bile acids
• MLH1 hypermethylation
• population-based

Acknowledgements

We are grateful for all the work GuĐríĐur Helga Ólafsdóttir at Icelandic Cancer institution has done for the study. We also wish to thank Ingibjörg Richter, Kristín K. Alexíusdóttir and GunnhildurJóhannsdóttir for their contributions to this project.

Disclosure statement

No potential conflict of interest was reported by the authors.