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Journal of Clinical and Translational Research 2023; 9(5): 308-316
Journal of Clinical and Translational Research
Journal homepage: http://www.jctres.com/en/home
REVIEW ARTICLE
Association of appendectomy with colorectal cancer: a systematic review
and meta-analysis
Busara Songtanin *, Narisara Tribuddharat , Chanaka Kahathuduwa , Kenneth Nugent 1
1
1
2
2
1 Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA, Department of Medicine, School of Medicine,
Siriraj Hospital, Mahidol University, Bangkok, Thailand
ARTICLE INFO ABSTRACT
Article history: Background: Appendectomy is a common surgical procedure done worldwide. The appendix is
Received: July 20, 2023 known as a sanctuary for commensal organisms in the gut, and an inflamed appendix may alter the
Revised: August 20, 2023 gut microbiome, leading to inflammation and oncogenesis. An association between appendectomy
Accepted: August 20, 2023 and subsequent colorectal cancer development has been postulated; however, previous studies have
Published online: September 15, 2023 differed in study design and results.
Method: We performed a systematic review and meta-analysis of studies evaluating the association
Keywords: between appendectomy and colorectal cancer in adults. A literature search of MEDLINE and EMBASE
Appendectomy was conducted through September 2022. Search terms included “appendectomy” and “colon cancer”
Colorectal cancer or “rectal cancer” or “colorectal cancer.” Odds ratios and sensitivity analyses were calculated.
Colon cancer Result: Of the 541 studies identified in our search, 10 studies met our inclusion criteria. The
Rectal cancer eight papers that studied the association between appendectomy and colorectal cancer reported no
Colon cancer screening association with the odds ratio (OR) of 1.30 (0.92, 1.83). However, studies on the association of
appendectomy and proximal versus distal colon cancer reported a statistically significant increase in
*Corresponding author: proximal colon cancer compared to distal colon cancer OR of 1.48 (1.29, 1.69).
Busara Songtanin Conclusion: Our study demonstrates that appendectomy is associated with the development of
Department of Internal Medicine, Texas Tech proximal colon cancer but not distal colon cancer.
University Health Sciences Center, Lubbock, Relevance for patients: Patients who have had an appendectomy should be aware of the potentially
TX, USA. increased risk for colon cancer. Consequently, they should provide this information during routine
Email: busara.songtanin@ttuhsc.edu clinic visits, especially if they are having gastrointestinal symptoms.
© 2023 Author(s). This is an Open-Access
article distributed under the terms of the
Creative Commons Attribution-Noncommercial 1. Introduction
License, permitting all non-commercial use,
distribution, and reproduction in any medium, According to the World Health Organization, colorectal cancer was the third most
provided the original work is properly cited. common cancer worldwide with approximately 1.93 million cases reported in 2020. Despite
increasing screening measures, colorectal cancer remained the second most common cause
of cancer death (916,000 deaths in 2020) [1]. Identifying possible risks for colorectal cancer
is important because colorectal cancer screening can result in early detection. Common risk
factors include age over 50 years, a family history of colorectal cancer, certain predisposing
genes, and long-standing inflammatory bowel disease. Potentially modifiable factors include
obesity, smoking, and heavy alcohol consumption [2]. Surprisingly, several studies have
suggested that an appendectomy is a risk factor for developing colorectal cancer; however,
this association has not been established [3-5].
Appendectomy is a common surgical procedure done worldwide. The previous studies
have shown appendectomy can alter the gut microbiome, depriving the colon of a backup
reserve of diverse commensal bacteria in case of diseases, such as diarrhea [6]. It may also
DOI: http://dx.doi.org/10.18053/jctres.09.202305.23-00090
