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Medicine (Baltimore). 2016;95(15):e3157.

Risk Factors for Gallstone Formation in Resected Gastric Cancer Patients.

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제1저자 백규현 · 교신저자 김재환

소속 (1)
  1. From the Department of Internal Medicine (K-HP, J-CL, HWK, JK, J-HH, JK); Department of Surgery (SHA, DJP, H-HK), Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si; and Department of Internal Medicine (YSL), Keimyung University School of Medicine, Daegu, Korea.

Abstract

Previous studies reported increased incidence of gallstone formation after gastrectomy. However, there were few reports about factors other than surgical technique. The purpose of this study is to investigate the spectrum of risk factors of gallstone formation after gastrectomy. From June 2003 to December 2008, 1480 patients who underwent gastrectomy due to gastric cancer but had no gallstones before surgery were identified. Electronic medical records were retrospectively reviewed. Gallstones were assessed by computerized tomography or ultrasound performed as surveillance for recurrence. There were 987 men (66.7%) and the median age was 59.0 years. The median follow-up period was 47.0 months. According to the surgical technique, 754 (50.9%), 459 (31.1%), and 267 (18.0%) underwent subtotal gastrectomy with Billroth I (STG B-I) and Billroth II (STG B-II) anastomosis, and total gastrectomy (TG). Within the follow-up period, gallstone formation occurred in 106 of 1480 patients (7.2%), the only 9 patients (0.6%) experienced symptomatic cholecystitis. By multivariate Cox regression analysis, age (HR 1.02, 95% CI 1.00-1.04), male (1.65, 1.02-2.67), diabetes mellitus (2.15, 1.43-3.24), ≥4% decrease of body mass index after surgery (1.66, 1.02-2.70), STG B-II (1.63, 1.03-2.57), and TG (2.35, 1.43-3.24) compared with STG B-I were associated with gallstone formation. Common bile duct stone formation occurred in 20 of 1480 patients (1.4%) and was only associated with gallstones. After gastrectomy, there were considerable numbers of patients with newly developed gallstones; however, prophylactic cholecystectomy should not be routinely recommended. Gastrectomy (STG B-II or TG), old age, male sex, diabetes mellitus, and decreased body mass index were associated with gallstones.

Figures

FIGURE 1
FIGURE 1 Kaplan–Meier analysis of cumulative incidence of postgastrectomy cholelithiasis according to type of surgery. A, The incidence of gallstones was significantly higher after subtotal and total gastrectomy compared with control (after wedge resection) group (P = 0.035). B, The incidence of gallstones was significantly higher after total gastrectomy than subtotal gastrectomy (P = 0.001). C, The incidence of gallstones was significantly higher after total gastrectomy or subtotal gastrectomy with Billroth II anastomosis than subtotal gastrectomy with Billroth I ananstomosis (P < 0.001 and P = 0.043). Although the incidence of gallstones tended to be higher after total gastrectomy than subtotal gastrectomy, there was no statistically significant difference (P = 0.084). D, The cumulative incidence of gallstone formation was not significantly different between the patients after open and laparoscopic gastrectomy (P = 0.377).
FIGURE 2
FIGURE 2 Kaplan–Meier analysis of cumulative incidence of cholecystitis revealed that postgastrectomy cholelithiasis is a significant contributing factor for cholecystitis (P < 0.001).
FIGURE 3
FIGURE 3 Kaplan–Meier analysis of choledocholithiasis after gastrectomy according to type of surgery revealed that there was no difference among the 3 groups (P = 0.103).

그림 출처: PubMed Central 공개 논문 (PMC4839799)

Conflict of interest statement

The authors have no conflicts of interest to disclose.

그 밖의 정보
출판 형태
Journal Article, Observational Study
저널
Medicine · eISSN 1536-5964
MeSH
Adult · Age Factors · Aged · Aged, 80 and over · Diabetes Mellitus / epidemiology · Female · Gallstones / epidemiology · Gastrectomy / methods / statistics & numerical data · Humans · Incidence · Male · Middle Aged · Regression Analysis · Retrospective Studies · Sex Factors · Stomach Neoplasms / surgery · Weight Loss
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