title: Is Routine Prophylactic Cholecystectomy Necessary During Gastrectomy for Gastric Cancer?
abstract: Performing routine prophylactic cholecystectomy during gastrectomy in gastric cancer patients has been controversial. The frequency of cholelithiasis, cholecystitis, and cholangitis after gastrectomy has not been reported for large patient populations, so we carried out this retrospective study to aid the assessment of the necessity for prophylactic cholecystectomy.
  
  
  
  This retrospective study reviewed 969 patients with gastric cancer who underwent distal gastrectomies with Billroth I reconstructions (DG) or total gastrectomies with Roux-en-Y reconstructions (TG), preserving the gallbladder, between January 2000 and May 2012. Risk factors for cholelithiasis, cholecystitis, and cholangitis after gastrectomy were evaluated using logistic regression analysis.
  
  
  
  The median follow-up period after gastrectomy was 48 months (range 12-159 months). After gastrectomy, cholelithiasis occurred in 6.1% (59/969) patients and cholecystitis and/or cholangitis occurred in 1.2% (12/969) patients. The method used for gastrectomy was an independent risk factor for both cholelithiasis (TG/DG: OR (95%CI): 1.900 (1.114-3.240), p = 0.018) and cholecystitis and/or cholangitis (TG/DG: OR (95%CI): 8.325 (1.814-38.197), p = 0.006). In patients who developed cholelithiasis, the incidence of cholecystitis and/or cholangitis was 31.3% (10/32) after TG, but only 7.4% after DG.
  
  
  
  Prophylactic cholecystectomy may be unnecessary in distal gastrectomy with Billroth I reconstruction.
authors.affiliation: Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan. kimjun77jp@yahoo.co.jp.
authors.forename: Jun
authors.initials: J
authors.lastname: Kimura
authors.affiliation: Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan.
authors.forename: Chikara
authors.initials: C
authors.lastname: Kunisaki
authors.affiliation: Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Takagawa
authors.affiliation: Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan.
authors.forename: Hirochika
authors.initials: H
authors.lastname: Makino
authors.affiliation: Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan.
authors.forename: Michio
authors.initials: M
authors.lastname: Ueda
authors.affiliation: Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan.
authors.forename: Mitsuyoshi
authors.initials: M
authors.lastname: Ota
authors.affiliation: Department of Biostatistics and Epidemiology, Graduate School of Medicine, Yokohama City University Medical Center, Yokohama, Japan.
authors.forename: Mari
authors.initials: M
authors.lastname: Oba
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kosaka
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan.
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Akiyama
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan.
authors.forename: Itaru
authors.initials: I
authors.lastname: Endo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy / Q000379:methods*; D005260:Female; D005705:Gallbladder Diseases / Q000601:surgery; D005743:Gastrectomy / Q000379:methods*; D005763:Gastroenterostomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000601:surgery*