Cholelithiasis and cholecystitis after gastrectomy for gastric carcinoma: a comparison of lymphadenectomy of varying extent.
OBJECTIVE
The complications of cholelithiasis and cholecystitis after gastrectomy for gastric carcinoma were reviewed.


METHODS
Between 1983 and 1988, 474 patients with a normal gallbladder received gastrectomy for gastric cancer.


RESULTS
Among the 288 patients who underwent radical gastrectomy with systematic lymphadenectomy (RG), 9 (3.1%) were suffering from acute postoperative acalculous cholecystitis, and 2 of them died. None of the 186 patients treated with simple gastrectomy (SG) developed this complication (RG vs. SG, p <0.05). The long-term prognosis of RG is better than that of SG. However, as of July 1993, of among the 463 patients with a normal gallbladder who survived the operation, 85 of the 281 patients who underwent RG and 9 of the 182 patients who underwent SG had gallstones (RG vs. SG, P<0.001). Of the cases complicated by postgastrectomy cholelithiasis, the mean interval between gastrectomy and gallstone formation was shorter in the RG patients (31.4 +/- 20.9 months) than in the SG patients (48.0 +/- 12.8 months) (P<0.05). Following gallstone formation, there was a higher rate of acute biliary symptoms in patients who underwent RG.


CONCLUSIONS
Early cholecystectomy should be performed in patients who received an RG with gallstone formation. Moreover, it would be better to include a policy of prophylactic cholecystectomy in the procedures of RG, even if the gallbladder is normal, in order to prevent the complications of acute cholecystitis and cholelithiasis.
Wu
C C
CC
Department of Surgery, Taichung Veterans General Hospital, Taiwan.
Chen
C Y
CY
Wu
T C
TC
Iiu
T J
TJ
P'eng
P K
PK
D000208:Acute Disease; D000368:Aged; D016022:Case-Control Studies; D002763:Cholecystectomy; D002764:Cholecystitis / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D002769:Cholelithiasis / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects; D008875:Middle Aged; D011178:Postgastrectomy Syndromes / Q000453:epidemiology* / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome