title: Gallstone disease after extended (D2) lymph node dissection for gastric cancer.
abstract: Few studies have reported the incidence and clinical outcomes of gallstone disease after extended (D2) lymph node dissection for gastric cancer. The present study was designed to retrospectively compare limited (D1) and D2 dissections in terms of gallstone formation, presentation of gallstones, and surgery for gallstone disease. A total of 805 Japanese gastric cancer patients (595 male, 210 female) who underwent curative resection with D1 (n = 490) or D2 (n = 315) dissection were retrospectively reviewed. Of those subjects followed for 70.5 +/- 44.3 months (range: 2-196 months), 102 (12.7%) developed gallstones. The incidence of gallstone formation was higher in the D2 group than in the D1 group (17.8% vs. 9.4%, p = 0.001). The interval between gastrectomy and detection of gallstones was shorter in the D2 group than in the Dl group (18.8 +/- 11.4 months vs. 29.4 +/- 18.3 months, p = 0.002). Of those with gallstones followed for 48.0 +/- 28.6 months (range: 1-158 months), 74 (72.5%) remained asymptomatic, and 15 (14.7%) experienced mild biliary pain. Thirteen patients (12.7%) developed recurrent biliary pain (n = 3) or biliary complications (n = 10; 6 acute cholecystitis, 3 obstructive jaundice, and 1 cholangitis), and required surgical treatment. Surgery was more frequently sought in the D2 group than in the D1 group (19.5% vs. 4.3%, p = 0.033). In conclusion, patients with D2 dissection developed gallstones more frequently and earlier than patients with D1 dissection. Of those with gallstones, patients with D2 dissection required surgery more often than patients with D1 dissection. A closer follow-up should be mandatory for gallstone disease after D2 dissection, but further studies are needed before generalizations can be made.
authors.affiliation: Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, 160-8582 Shinjyuku-ku, Tokyo, Japan.
authors.forename: Tomotaka
authors.initials: T
authors.lastname: Akatsu
authors.forename: Masashi
authors.initials: M
authors.lastname: Yoshida
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Kubota
authors.forename: Motohide
authors.initials: M
authors.lastname: Shimazu
authors.forename: Masakazu
authors.initials: M
authors.lastname: Ueda
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Otani
authors.forename: Go
authors.initials: G
authors.lastname: Wakabayashi
authors.forename: Koichi
authors.initials: K
authors.lastname: Aiura
authors.forename: Minoru
authors.initials: M
authors.lastname: Tanabe
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Furukawa
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Saikawa
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Kawachi
authors.forename: Yukako
authors.initials: Y
authors.lastname: Akatsu
authors.forename: Koichiro
authors.initials: K
authors.lastname: Kumai
authors.forename: Masaki
authors.initials: M
authors.lastname: Kitajima
mesh_terms: D000368:Aged; D002763:Cholecystectomy; D041761:Cholecystolithiasis / Q000453:epidemiology* / Q000601:surgery; D005260:Female; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D013274:Stomach Neoplasms / Q000601:surgery*