Background/Aims: Cholecystectomy is generally performed to treat patients with gallstone disease (GSD) in clinical practice. The present study aimed to investigate whether type 2 diabetes mellitus (T2DM) may influence the overall survival of GSD patients. Methods: The National Health Insurance Research Database, a population-based registry data in Taiwan, was used to identify GSD patients from 2001 to 2008. The risk of cancers and effects of T2DM on the overall survival of GSD patients receiving cholecystectomy were estimated by hazards ratios (HRs) and 95% CIs using the Cox proportional hazard model. Results: Among 392,028 eligible GSD patients, 81,971 underwent cholecystectomy, whereas 310,057 did not. After cholecystectomy, the HR for developing cancer was 1.14. The HR for the overall survival was 0.74-fold lower for patients who underwent cholecystectomy than that for patients who did not. GSD patients without T2DM who underwent cholecystectomy (0.78-fold lower risk) had a longer survival, whereas those with T2DM had shorter survival (1.64-fold higher risk without cholecystectomy and 1.13-fold higher risk with cholecystectomy) compared with those without T2DM who did not undergo cholecystectomy. Conclusions: Our major findings suggest that T2DM may worsen the prognosis of GSD patients after cholecystectomy, which provides useful insight into the treatment of T2DM among GSD patients in clinical settings.

1.
Shen HJ, Hsu CT, Tung TH: Economic and medical benefits of ultrasound screenings for gallstone disease. World J Gastroenterol 2015;21:3337-3343.
[PubMed]
2.
Stinton LM, Shaffer EA: Epidemiology of gallbladder disease: cholelithiasis and cancer. Gut Liver 2012;6:172-187.
[PubMed]
3.
Chen CH, Huang MH, Yang JC, Nien CK, Etheredge GD, Yang CC, Yeh YH, Wu HS, Chou DA, Yueh SK: Prevalence and risk factors of gallstone disease in an adult population of Taiwan: an epidemiological survey. J Gastroenterol Hepatol 2006;21:1737-1743.
[PubMed]
4.
Sun H, Tang H, Jiang S, Zeng L, Chen EQ, Zhou TY, Wang YJ: Gender and metabolic differences of gallstone diseases. World J Gastroenterol 2009;15:1886-1891.
[PubMed]
5.
Chen JY, Hsu CT, Liu JH, Tung TH: Clinical predictors of incident gallstone disease in a Chinese population in Taipei, Taiwan. BMC Gastroenterol 2014;14:83.
[PubMed]
6.
Weerakoon H, Navaratne A, Ranasinghe S, Sivakanesan R, Galketiya KB, Rosairo S: Chemical characterization of gallstones: an approach to explore the aetiopathogenesis of gallstone disease in Sri Lanka. PLoS One 2015;10: e0121537.
[PubMed]
7.
Lonardo A, Lombardini S, Scaglioni F, Ballestri S, Verrone AM, Bertolotti M, Carulli L, Ganazzi D, Carulli N, Loria P: Fatty liver, carotid disease and gallstones: a study of age-related associations. World J Gastroenterol 2006;12:5826-5833.
[PubMed]
8.
Palsson SH, Sandblom G: Influence of gender and socioeconomic background on the decision to perform gallstone surgery: a population-based register study. Scand J Gastroenterol 2015;50:211-216.
[PubMed]
9.
Li CP, Hwang SJ, Lee FY, Chang FY, Lin HC, Lu RH, Chu CJ, Lee SD: Evaluation of gallbladder motility in patients with liver cirrhosis: relationship to gallstone formation. Dig Dis Sci 2000;45:1109-1114.
[PubMed]
10.
Hao RR, Wang HJ, Jia JD, Li CL: [An investigation of the relationship of gallbladder motility and gallstone formation in patients with liver cirrhosis]. Zhonghua Gan Zang Bing Za Zhi 2006;14:137-138.
[PubMed]
11.
Stroffolini T, Sagnelli E, Mele A, Cottone C, Almasio PL; Italian Hospitals' Collaborating Group: HCV infection is a risk factor for gallstone disease in liver cirrhosis: an Italian epidemiological survey. J Viral Hepat 2007;14:618-623.
[PubMed]
12.
Schwesinger WH, Kurtin WE, Levine BA, Page CP: Cirrhosis and alcoholism as pathogenetic factors in pigment gallstone formation. Ann Surg 1985;201:319-322.
[PubMed]
13.
Moro PL, Checkley W, Gilman RH, Lescano G, Bonilla JJ, Silva B, Garcia HH: Gallstone disease in high-altitude Peruvian rural populations. Am J Gastroenterol 1999;94:153-158.
[PubMed]
14.
Ionescu DL: [The gallstone and arterial hypertension]. Rev Med Chir Soc Med Nat Iasi 2001;105:101-104.
[PubMed]
15.
Halldestam I, Kullman E, Borch K: Incidence of and potential risk factors for gallstone disease in a general population sample. Br J Surg 2009;96:1315-1322.
[PubMed]
16.
Wei CY, Chung TC, Chen CH, Lin CC, Sung FC, Chung WT, Kung WM, Hsu CY, Yeh YH: Gallstone disease and the risk of stroke: a nationwide population-based study. J Stroke Cerebrovasc Dis 2014;23:1813-1820.
[PubMed]
17.
Lv J, Qi L, Yu C, Guo Y, Bian Z, Chen Y, Yang L, Shen J, Wang S, Li M, Liu Y, Zhang L, Chen J, Chen Z, Li L; China Kadoorie Biobank Collaborative Group: Gallstone disease and the risk of ischemic heart disease. Arterioscler Thromb Vasc Biol 2015;35:2232-2237.
[PubMed]
18.
Wang W, Li N: The association of gallstone disease and diabetes mellitus. A meta-analysis. Saudi Med J 2014;35:1005-1012.
[PubMed]
19.
Friedrich N, Volzke H, Hampe J, Lerch MM, Jorgensen T: Known risk factors do not explain disparities in gallstone prevalence between Denmark and northeast Germany. Am J Gastroenterol 2009;104:89-95.
[PubMed]
20.
Melmer A, Sturm W, Kuhnert B, Engl-Prosch J, Ress C, Tschoner A, Laimer M, Laimer E, Biebl M, Pratschke J, Tilg H, Ebenbichler C: Incidence of gallstone formation and cholecystectomy 10 years after bariatric surgery. Obes Surg 2015;25:1171-1176.
[PubMed]
21.
Nijssen MA, Schreinemakers JM, Meyer Z, van der Schelling GP, Crolla RM, Rijken AM: Complications after laparoscopic cholecystectomy: a video evaluation study of whether the critical view of safety was reached. World J Surg 2015;39:1798-1803.
[PubMed]
22.
Steiner CA, Bass EB, Talamini MA, Pitt HA, Steinberg EP: Surgical rates and operative mortality for open and laparoscopic cholecystectomy in Maryland. N Engl J Med 1994;330:403-408.
[PubMed]
23.
Chen YK, Yeh JH, Lin CL, Peng CL, Sung FC, Hwang IM, Kao CH: Cancer risk in patients with cholelithiasis and after cholecystectomy: a nationwide cohort study. J Gastroenterol 2014;49:923-931.
[PubMed]
24.
Liu Y, He Y, Li T, Xie L, Wang J, Qin X, Li S: Risk of primary liver cancer associated with gallstones and cholecystectomy: a meta-analysis. PLoS One 2014;9:e109733.
[PubMed]
25.
Lin G, Zeng Z, Wang X, Wu Z, Wang J, Wang C, Sun Q, Chen Y, Quan H: Cholecystectomy and risk of pancreatic cancer: a meta-analysis of observational studies. Cancer Causes Control 2012;23:59-67.
[PubMed]
26.
Ekbom A, Hsieh CC, Yuen J, Trichopoulos D, McLaughlin JK, Lan SJ, Adami HO: Risk of extrahepatic bileduct cancer after cholecystectomy. Lancet 1993;342:1262-1265.
[PubMed]
27.
Reid FD, Mercer PM, harrison M, Bates T: Cholecystectomy as a risk factor for colorectal cancer: a meta-analysis. Scand J Gastroenterol 1996;31:160-169.
[PubMed]
28.
Almond HR, Vlahcevic ZR, Bell CC Jr, Gregory DH, Swell L: Bile acid pools, kinetics and biliary lipid composition before and after cholecystectomy. N Engl J Med 1973;289:1213-1216.
[PubMed]
29.
Gustavsson S, Adami HO, Meirik O, Nyren O, Krusemo UB: Cholecystectomy as a risk factor for gastric cancer. A cohort study. Dig Dis Sci 1984;29:116-120.
[PubMed]
30.
Lagergren J, Mattsson F: Cholecystectomy and risk of laryngeal and pharyngeal cancer. Int J Cancer 2012;130:2211-2214.
[PubMed]
31.
Ge Z, Zhao C, Wang Y, Qian J: Cholecystectomy and the risk of esophageal and gastric cancer. Saudi Med J 2012;33:1073-1079.
[PubMed]
32.
Cheng CL, Kao YH, Lin SJ, Lee CH, Lai ML: Validation of the National Health Insurance Research Database with ischemic stroke cases in Taiwan. Pharmacoepidemiol Drug Saf 2011;20:236-242.
[PubMed]
33.
Kang JH, Chen YH, Lin HC: Comorbidity profiles among patients with ankylosing spondylitis: a nationwide population-based study. Ann Rheum Dis 2010;69:1165-1168.
[PubMed]
34.
Gitelson S, Oppenheim D, Schwartz A: Size of the gallbladder in patients with diabetes mellitus. Diabetes 1969;18:493-498.
[PubMed]
35.
Fisher RS, Rock E, Malmud LS: Cholinergic effects on gallbladder emptying in humans. Gastroenterology 1985;89:716-722.
[PubMed]
36.
Hsu WC, Araneta MR, Kanaya AM, Chiang JL, Fujimoto W: BMI cut points to identify at-risk Asian Americans for type 2 diabetes screening. Diabetes Care 2015;38:150-158.
[PubMed]
37.
Scragg RK, Calvert GD, Oliver JR: Plasma lipids and insulin in gall stone disease: a case-control study. Br Med J (Clin Res Ed) 1984;289:521-525.
[PubMed]
38.
Persson GE, Thulin AJ: Prevalence of gallstone disease in patients with diabetes mellitus. A case-control study. Eur J Surg 1991;157:579-582.
[PubMed]
39.
Pagliarulo M, Fornari F, Fraquelli M, Zoli M, Giangregorio F, Grigolon A, Peracchi M, Conte D: Gallstone disease and related risk factors in a large cohort of diabetic patients. Dig Liver Dis 2004;36:130-134.
[PubMed]
40.
Chapman BA, Wilson IR, Frampton CM, Chisholm RJ, Stewart NR, Eagar GM, Allan RB: Prevalence of gallbladder disease in diabetes mellitus. Dig Dis Sci 1996;41:2222-2228.
[PubMed]
41.
Nakeeb A, Comuzzie AG, Al-Azzawi H, Sonnenberg GE, Kissebah AH, Pitt HA: Insulin resistance causes human gallbladder dysmotility. J Gastrointest Surg 2006;10:940-948.
[PubMed]
42.
Giovannucci E, Colditz GA, Stampfer MJ: A meta-analysis of cholecystectomy and risk of colorectal cancer. Gastroenterology 1993;105:130-141.
[PubMed]
43.
Tavani A, Rosato V, Di Palma F, Bosetti C, Talamini R, Dal Maso L, Zucchetto A, Levi F, Montella M, Negri E, Franceschi S, La Vecchia C: History of cholelithiasis and cancer risk in a network of case-control studies. Ann Oncol 2012;23:2173-2178.
[PubMed]
44.
Goldacre MJ, Abisgold JD, Seagroatt V, Yeates D: Cancer after cholecystectomy: record-linkage cohort study. Br J Cancer 2005;92:1307-1309.
[PubMed]
45.
Fall K, Ye W, Nyren O: Risk for gastric cancer after cholecystectomy. Am J Gastroenterol 2007;102:1180-1184.
[PubMed]
46.
Mantovani A, Allavena P, Sica A, Balkwill F: Cancer-related inflammation. Nature 2008;454:436-444.
[PubMed]
47.
Grivennikov SI, Greten FR, Karin M: Immunity, inflammation, and cancer. Cell 2010;140:883-899.
[PubMed]
48.
Leandros E, Alexakis N, Archontovasilis F, Albanopoulos K, Dardamanis D, Menenakos E, Tsigris C, Giannopoulos A: Outcome analysis of laparoscopic cholecystectomy in patients aged 80 years and older with complicated gallstone disease. J Laparoendosc Adv Surg Tech A 2007;17:731-735.
[PubMed]
49.
Schnelldorfer T: Porcelain gallbladder: a benign process or concern for malignancy? J Gastrointest Surg 2013;17:1161-1168.
[PubMed]
50.
Aldouri AQ, Malik HZ, Waytt J, Khan S, Ranganathan K, Kummaraganti S, Hamilton W, Dexter S, Menon K, Lodge JP, Prasad KR, Toogood GJ: The risk of gallbladder cancer from polyps in a large multiethnic series. Eur J Surg Oncol 2009;35:48-51.
[PubMed]
51.
Axelrad JE, Lichtiger S, Yajnik V: Inflammatory bowel disease and cancer: the role of inflammation, immunosuppression, and cancer treatment. World J Gastroenterol 2016;22:4794-4801.
[PubMed]
52.
Polo M, Duclos A, Polazzi S, Payet C, Lifante JC, Cotte E, Barth X, Glehen O, Passot G: Acute cholecystitis-optimal timing for early cholecystectomy: a French Nationwide Study. J Gastrointest Surg 2015;19:2003-2010.
53.
Cao AM, Eslick GD, Cox MR: Early cholecystectomy is superior to delayed cholecystectomy for acute cholecystitis: a meta-analysis. J Gastrointest Surg 2015;19:848-857.
[PubMed]
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