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Risk of tuberculosis after endoscopic resection and gastrectomy in gastric cancer: nationwide population-based matched cohort study

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Abstract

Background

This study aimed to investigate the association between gastrectomy and endoscopic resection for gastric cancer and the subsequent tuberculosis incidence.

Methods

We conducted a nationwide matched cohort study using data from the Korea National Health Insurance Service from 2013 to 2019. We created two cohorts: patients who underwent gastrectomy and those who had endoscopic resection. Each patient was matched 1:1 with an unexposed individual based on index year, age, sex, income, and various comorbidities. The primary outcome was the incidence of tuberculosis during the follow-up period.

Results

Our study comprised 90,886 gastrectomy patients and 46,759 endoscopic resection patients. The tuberculosis incidence was significantly higher in the gastrectomy group compared to its matched non-gastrectomy group (IRR 1.69, 95% CI 1.43–1.99, p < .001). In contrast, there was no significant difference in tuberculosis incidence between the endoscopic resection group and its matched non-resection group (IRR 0.95, 95% CI 0.75–1.19, p = 0.627). The Kaplan–Meier cumulative incidence also did not differ between the two groups. However, tuberculosis incidence significantly increased in the first year after endoscopic resection.

Conclusion

Gastrectomy for gastric cancer is associated with a higher incidence of subsequent tuberculosis, while no significant association was observed for endoscopic resection. However, tuberculosis incidence increases significantly during the first year after endoscopic resection.

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Funding

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Authors and Affiliations

  1. Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Korea

    Hye Sung Khil, Sue In Choi, Byung-Keun Kim, Eun Joo Lee, Sang Yeub Lee & Won Jai Jung

  2. Department of Biostatistics, Korea University College of Medicine, Seoul, Korea

    Ji Hyun Kim

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  1. Hye Sung Khil
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Contributions

HSK: designed the study, managed data collection, analyzed the data, and wrote the article. WJJ: designed the study and wrote the article. JHK: managed data collection and analyzed the data. SIC, B-KK, ENJL, SYL: designed the study and managed data collection.

Corresponding author

Correspondence to Won Jai Jung.

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Disclosures

Hye Sung Khil, Sue In Choi, Byung-Keun Kim, Eun Joo Lee, Sang Yeub Lee, Ji Hyun Kim, and Won Jai Jung have no conflicts of interest or financial ties to disclose.

Ethical approval

This study was approved by Institutional Review Board (IRB) of Korea University Anam Hospital (IRB No. 2020AN0401). The review board waived written informed consent because the data are public and anonymized under confidentiality guidelines.

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Khil, H.S., Choi, S.I., Kim, BK. et al. Risk of tuberculosis after endoscopic resection and gastrectomy in gastric cancer: nationwide population-based matched cohort study. Surg Endosc 38, 1358–1366 (2024). https://doi.org/10.1007/s00464-023-10610-z

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  • DOI: https://doi.org/10.1007/s00464-023-10610-z

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