S3099 Increased Risk of Small Bowel Cancer Following Cholecystectomy: A Propensity Score-Matched Analysis

Introduction: While cholecystectomy is a common surgical intervention for gallbladder disease, emerging evidence suggests a potential association with increased risk of gastrointestinal malignancies, including small bowel cancer (SBC). We conducted a large-scale, propensity-matched cohort analysis to assess the risk of SBC and its subtypes following cholecystectomy, stratified by gender and age group. Methods: Using the TriNetX electronic health records network, patients who underwent cholecystectomy were matched 1:1 with general population controls. Outcomes included SBC and its subtypes (duodenum, jejunum, ileum, combined jejunum/ileum, and unspecified sites). Hazard ratios (HR) and 95% confidence intervals (CI) were calculated via Kaplan–Meier survival analysis, stratified by gender and age group (18–45, 45–60, >60 years). Results: A total of 613,091 patients who underwent cholecystectomy were included (mean age 48.5 ± 18.1 years, 68.1% female, and 71.2% White). Cholecystectomy was associated with an increased risk of SBC across all subgroups. In gender-stratified analyses, Males consistently exhibited higher hazard ratios (HRs) across all cancer subtypes, with the highest observed in ileum cancer (HR 4.71; 95% CI: 2.60–8.55; P = 0.004). Females also showed significantly elevated risks, though generally of lower magnitude. The risk of small bowel cancer increased with age. Patients over 60 had the highest hazard ratios, notably for unspecified small bowel cancer (HR 4.40; 95% CI: 3.49–5.55; P = 0.001) and duodenal cancer (HR 3.01; 95% CI: 2.48–3.66; P < 0.001). The 45–60 age group showed elevated risks for duodenal cancer (HR 2.46; 95% CI: 1.65–3.67) and overall small bowel cancer (HR 2.61; 95% CI: 2.00–3.40; P = 0.013). Although the 18–45 group had the highest point estimate for ileum cancer (HR 7.96; 95% CI: 0.96–66.17), it was not statistically significant. Conclusion: Cholecystectomy is independently associated with an increased risk of small bowel cancer. The elevated risk persists across genders and is most pronounced in males and older adults. These findings highlight the need for age- and sex-specific risk assessment in clinical practice and support further research into tailored screening and early diagnostic strategies for small bowel malignancies post-cholecystectomies.