The Cholegas trial: long-term results of prophylactic cholecystectomy during gastrectomy for cancer—a randomized-controlled trial
The incidence of cholelithiasis has been shown to be higher for patients after gastrectomy than for the general population, due to vagal branch damage and gastrointestinal reconstruction. The aim of this trial was to evaluate the need for routine concomitant prophylactic cholecystectomy (PC) during gastrectomy for cancer.
A multicenter, randomized, controlled trial was conducted between November 2008 and March 2017. Of the total 130 included patients, 65 underwent PC and 65 underwent standard gastric surgery only for curable cancers. The primary endpoint was cholelithiasis-free survival after gastrectomy for gastric adenocarcinoma. Cholelithiasis was detected by ultrasound exam.
After a median follow-up of 62 months, eight patients (12.3%) in the control group developed biliary abnormalities (four cases of gallbladder calculi and four cases of biliary sludge), with only three (4.6%) being clinically relevant (two cholecystectomies needed, one acute pancreatitis). One patient in the PC group had asymptomatic biliary dilatation during sonography after surgery. The cholelithiasis-free survival did not show statistical significance between the two groups (P = 0.267). The number needed to treat with PC to avoid reoperation for cholelithiasis was 1:32.5.
Concomitant PC during gastric surgery for malignancies, although reducing the absolute number of biliary abnormalities, has no significant impact on the natural course of patients.
KeywordsProphylactic cholecystectomy Gastric surgery Gastric cancer
Italian Research Group for Gastric Cancer (GIRCG): Other surgeons who participated in the study were Marco Bernini, MD, PhD (Surgical Oncology, Careggi University Hospital, Florence, Italy), Leonardo Gerard, MD (General Surgery, Ospedale Carlo Poma, Mantova, Italy), Renato Moretti (Surgical Oncology, Careggi University Hospital, Florence, Italy), Luca Cozzaglio, MD (Division of Surgical Oncology, Humanitas Hospital, Milan, Italy), Stefano Berardi, MD (Surgical Oncology Catholic University, Campobasso, Italy), and Paolo Bechi (General Surgery, Careggi University Hospital, Florence, Italy).
The native English-speaking translation was supported by the funds of the University of Florence, Italy.
Compliance with ethical standards
Conflict of interest
The authors have no conflicts of interest to declare.
A formal approval by the ethics committee of each participating center was obtained before the trial started recruitment.
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