Analysis of gallstone disease after gastric cancer surgery.
BACKGROUND
The incidence rate of newly developed gallstone disease after gastrectomy for gastric cancer is thought to be higher than that in the general population. However, the presentation and management of these gallstones remain under debate, and the role of prophylactic cholecystectomy remains questionable.


METHODS
Data on adult patients who were diagnosed with gastric cancer and received gastrectomy between 2000 and 2011 were extracted from the Taiwan National Health Insurance Research Database. A patient was excluded if he or she had gallstone disease or received cholecystectomy before the index date. The incidence of newly developed gallstone disease and its subsequent management were recorded. Data were analyzed to evaluate the factors associated with gallstone development and treatment options.


RESULTS
A total of 17,325 gastric cancer patients who underwent gastrectomy were eligible for analysis. During the follow-up period (mean 4.1 years; median, 2.9 years), 1280 (7.4%) patients developed gallstone disease and 560 (3.2%) patients subsequently underwent cholecystectomy. The in-hospital mortality for cholecystectomy was 1.8% (10/560). Development of gallstone disease was associated with older age, total gastrectomy, duodenal exclusion, diabetes, cirrhosis, and more comorbidities. Factors associated with the use of cholecystectomy to treat gallstone disease included younger age, fewer comorbidities, medical center admission, and presentation as cholecystitis.


CONCLUSIONS
Although few patients required further gallbladder removal after gastrectomy for gastric malignancy, the increased mortality rate for subsequent cholecystectomy was worth noting. The decision to undergo prophylactic cholecystectomy might be individualized based upon patient characteristics and the surgeon's discretion.
Division of General Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd, Zuoying District, Kaohsiung, 81362, Taiwan.
Tsung-Jung
TJ
Liang
Division of General Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd, Zuoying District, Kaohsiung, 81362, Taiwan.|School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Shiuh-Inn
SI
Liu
Division of General Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd, Zuoying District, Kaohsiung, 81362, Taiwan.
Yu-Chia
YC
Chen
Division of General Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd, Zuoying District, Kaohsiung, 81362, Taiwan.
Po-Min
PM
Chang
School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Critical Care Center and Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
Wei-Chun
WC
Huang
Division of General Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd, Zuoying District, Kaohsiung, 81362, Taiwan.|School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Hong-Tai
HT
Chang
Division of General Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd, Zuoying District, Kaohsiung, 81362, Taiwan. nugaticc@gmail.com.
I-Shu
http://orcid.org/0000-0002-4191-4680
IS
Chen
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy / Q000379:methods* / Q000401:mortality; D002764:Cholecystitis / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000601:surgery*; D013624:Taiwan
Cholecystectomy; Cholecystitis; Gallstone; Gastrectomy; Gastric cancer