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Is Routine Prophylactic Cholecystectomy Necessary During Gastrectomy for Gastric Cancer?

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Abstract

Background

Performing routine prophylactic cholecystectomy during gastrectomy in gastric cancer patients has been controversial. The frequency of cholelithiasis, cholecystitis, and cholangitis after gastrectomy has not been reported for large patient populations, so we carried out this retrospective study to aid the assessment of the necessity for prophylactic cholecystectomy.

Methods

This retrospective study reviewed 969 patients with gastric cancer who underwent distal gastrectomies with Billroth I reconstructions (DG) or total gastrectomies with Roux-en-Y reconstructions (TG), preserving the gallbladder, between January 2000 and May 2012. Risk factors for cholelithiasis, cholecystitis, and cholangitis after gastrectomy were evaluated using logistic regression analysis.

Results

The median follow-up period after gastrectomy was 48 months (range 12–159 months). After gastrectomy, cholelithiasis occurred in 6.1% (59/969) patients and cholecystitis and/or cholangitis occurred in 1.2% (12/969) patients. The method used for gastrectomy was an independent risk factor for both cholelithiasis (TG/DG: OR (95%CI): 1.900 (1.114–3.240), p = 0.018) and cholecystitis and/or cholangitis (TG/DG: OR (95%CI): 8.325 (1.814–38.197), p = 0.006). In patients who developed cholelithiasis, the incidence of cholecystitis and/or cholangitis was 31.3% (10/32) after TG, but only 7.4% after DG.

Conclusions

Prophylactic cholecystectomy may be unnecessary in distal gastrectomy with Billroth I reconstruction.

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Acknowledgements

The authors thank Drs. Nobuhiro Sugano, Hidetaka Ono, and Takashi Oshima for their helpful comments and their invaluable support for this study, and Drs. Yasuhiro Shimizu, Masanori Oshi, Nobuhiro Tsuchiya, and Shigeya Hayashi for assisting with data collection.

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Authors and Affiliations

  1. Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan

    Jun Kimura, Chikara Kunisaki, Ryo Takagawa, Hirochika Makino, Michio Ueda & Mitsuyoshi Ota

  2. Department of Biostatistics and Epidemiology, Graduate School of Medicine, Yokohama City University Medical Center, Yokohama, Japan

    Mari Oba

  3. Department of Gastroenterological Surgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan

    Takashi Kosaka, Hirotoshi Akiyama & Itaru Endo

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  1. Jun Kimura
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  2. Chikara Kunisaki
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  3. Ryo Takagawa
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Correspondence to Jun Kimura.

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Kimura, J., Kunisaki, C., Takagawa, R. et al. Is Routine Prophylactic Cholecystectomy Necessary During Gastrectomy for Gastric Cancer?. World J Surg 41, 1047–1053 (2017). https://doi.org/10.1007/s00268-016-3831-4

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