Abstract
BackgroundPerformance of gastrectomy in gastric cancer patients can lead to an increased incidence of cholecystolithiasis (CL) and a higher morbidity rate. However, the value of prophylactic cholecystectomy performed during gastric cancer surgery is still being debated.MethodsWe carried out a retrospective study on patients with gastric cancer who underwent subtotal or total gastrectomy, with preservation of the gallbladder or simultaneous cholecystectomy from January 2010 to March 2018.ResultsCholecystolithiasis occurred in 152 of 1691 (8.98%) patients after gastric cancer surgery, with 45 (2.67%) patients undergoing subsequent cholecystectomy. Postoperative body mass index (BMI) decrease > 5% in 3 months was an independent risk factor for cholecystolithiasis [BMI decrease > 5%/≤5%: OR (95%CI): 1.812 (1.225–2.681), p = 0.003). Gastrectomy method and diabetes mellitus were independent risk factors for both cholecystolithiasis [gastrectomy method (no-Billroth I/Billroth I): OR (95%CI): 1.801 (1.097–2.959), p = 0.002; diabetes mellitus (yes/no): OR (95%CI): 1.544 (1.030–2.316), p = 0.036] and subsequent cholecystectomy [gastrectomy method (no-Billroth I/Billroth I): OR (95%CI): 5.432 (1.309–22.539), p = 0.020; diabetes mellitus (yes/no): OR (95%CI): 2.136 (1.106–4.125), p = 0.024]. Simultaneous cholecystectomy was performed in 62 of 1753 (3.5%) patients. The mortality and morbidity rates did not differ significantly between the combined surgery group and the gastrectomy only group (8.1% vs. 8.9 and 1.6% vs. 2.2%, respectively, p > 0.05).ConclusionsProphylactic cholecystectomy may be necessary in gastric cancer patients without Billroth I gastrectomy and with diabetes mellitus. Simultaneous cholecystectomy during gastric cancer surgery does not increase the postoperative mortality and morbidity rates.
Highlights
Performance of gastrectomy in gastric cancer patients can lead to an increased incidence of cholecystolithiasis (CL) and a higher morbidity rate
It is generally accepted that performance of gastrectomy in gastric cancer patients can lead to an increased incidence of cholecystolithiasis (CL) and a higher rate of morbidities that require secondary surgery [1], which may related with the complex interaction between sectioning of the nerve supply to the gallbladder and the change in cholecystokinin secretion [2, 3]
45 patients underwent a secondary cholecystectomy followed the following surgical indications: cholecystolithiasis combined with conservative treatment of uncontrollable cholecystitis; complicated with acute pancreatitis; gallstones larger than 2 cm in diameter; cholecystolithiasis combined with gallbladder polyp; porcelain gallbladder; gallbladder atrophy; gallbladder filling stones; gallstones located in the gallbladder ampulla abdomen or gallbladder duct
Summary
Performance of gastrectomy in gastric cancer patients can lead to an increased incidence of cholecystolithiasis (CL) and a higher morbidity rate. The value of prophylactic cholecystectomy performed during gastric cancer surgery is still being debated. It is generally accepted that performance of gastrectomy in gastric cancer patients can lead to an increased incidence of cholecystolithiasis (CL) and a higher rate of morbidities that require secondary surgery [1], which may related with the complex interaction between sectioning of the nerve supply to the gallbladder and the change in cholecystokinin secretion [2, 3]. Performance of routine prophylactic cholecystectomy during radical gastrectomy is still being debated [4]. The influences of simultaneous cholecystectomy on surgical mortality and morbidity of gastric cancer patients were evaluated.
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