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Prophylactic Cholecystectomy at Time of Surgery for Small Bowel Neuroendocrine Tumor Does Not Increase Postoperative Morbidity

Annals of Surgical Oncology volume 25, pages 239–245 (2018)Cite this article

Abstract

Background

Prophylactic cholecystectomy at time of surgery for small bowel neuroendocrine tumor (SBNET) has been advocated, as these patients often go on to require somatostatin analogue therapy, which is known to increase risk of cholestasis and associated complications. Little is known regarding patterns of adoption of this practice or its associated morbidity.

Methods

The American College of Surgeons National Surgical Quality Improvement Program database (2008–2014) was queried to identify patients who underwent SBNET resection. The risk differences of morbidity and mortality associated with performance of concurrent cholecystectomy were determined with multivariable adjustment for confounders.

Results

Among 1300 patients who underwent SBNET resection, 144 (11.1%) underwent concurrent cholecystectomy. Median age of patients undergoing cholecystectomy was 62 years [interquartile range (IQR) 52–69 years], and 75 were male. They more commonly had disseminated cancer (36.1 vs. 11.6%, p < 0.001) or SBNET located in duodenum (10.4 vs. 4.9%, p = 0.045) without difference in other baseline characteristics. Operative time was significantly longer in the cholecystectomy group (median 172 vs. 123 min, p < 0.001). Rate of postoperative morbidity was not significantly different between cholecystectomy and no-cholecystectomy groups (11.8 vs. 11.1%, p = 0.79). After adjustment for confounding, the risk difference of morbidity attributable to cholecystectomy was + 0.4% [95% confidence interval (CI) − 4.9 to + 5.6%]. Mortality within 30 days was not significantly different between cholecystectomy and no-cholecystectomy groups (1.4 vs. 0.6%, p = 0.29).

Conclusions

Concurrent cholecystectomy at time of resection of SBNET is not associated with higher morbidity or mortality yet is performed in a minority of patients. Prospective study can identify which patients may derive benefit from this approach.

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Authors and Affiliations

  1. Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    Andrew J. Sinnamon MD, Madalyn G. Neuwirth MD, Charles C. Vining MD, Catherine E. Sharoky MD, Rachel R. Kelz MD, MSCE, Douglas L. Fraker MD, Robert E. Roses MD & Giorgos C. Karakousis MD

  2. Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA

    Andrew J. Sinnamon MD & Yu-Xiao Yang MD, MSCE

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  1. Andrew J. Sinnamon MD
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  2. Madalyn G. Neuwirth MD
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  3. Charles C. Vining MD
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  4. Catherine E. Sharoky MD
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  5. Yu-Xiao Yang MD, MSCE
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  6. Rachel R. Kelz MD, MSCE
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  7. Douglas L. Fraker MD
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  8. Robert E. Roses MD
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  9. Giorgos C. Karakousis MD
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Correspondence to Andrew J. Sinnamon MD.

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Sinnamon, A.J., Neuwirth, M.G., Vining, C.C. et al. Prophylactic Cholecystectomy at Time of Surgery for Small Bowel Neuroendocrine Tumor Does Not Increase Postoperative Morbidity. Ann Surg Oncol 25, 239–245 (2018). https://doi.org/10.1245/s10434-017-6093-y

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  • DOI: https://doi.org/10.1245/s10434-017-6093-y

Keywords

  • Small Bowel Neuroendocrine Tumors (SBNET)
  • Prophylactic Cholecystectomy
  • Concurrent Cholecystectomy
  • Somatostatin Analog Therapy
  • National Surgical Quality Improvement Program