Clinical Significance of Cholelithiasis after Gastric Resection in Gastric Cancer Patients

ABSTRACT

PURPOSE: It is well known that the incidence of cholelithiasis and cholecystitis increases after a gastrectomy and vagotomy for peptic ulcer disease, but operations for ulcers have decreased due to improved medical therapy. However, there are not so many studies about cholelithiasis and cholecystitis after a gastric resection due to gastric cancer. Therefore, we investigated its incidence, the factors affecting it, and its natural course. METHODS: Six hundred eighty-four gastric patients who had received a gastric resection at the Korea University Guro Hospital from January 1992 to October 1999 and who had been followed regularly with abdominal ultrasonography or computed tomography were enrolled in this study. The incidence of gallstones and sludge was investigated according to age group (60), sex, extent of gastric resection (subtotal vs total), anastomotic methods (duodenal bypass vs duodenal passage of food), and degree of lymph node dissection ( or =D2+alpha). The clinical course of cholelithiasis was also followed up. RESULTS: Gallstones were discovered in 38 patients (5.6%) with a mean duration of 26.4+/-20.7 months, and sludge was found in 17 patients (2.5%) with a mean duration of 25.1+/-20.5 months. There were no significant differences of incidence of gallstones and sludge according to sex, age group, and other surgical options (p>0.05). Twenty- eight cases of gallstones (73.7%) were detected within 36 months, and 11 cases of sludge (64.7%) within 24 months. Among the 38 gallstones patient, only 7 patients (18.4%) developed acute cholecystitis; they received cholecystectomy during the follow-up period, and all removed stones were pigment stones. CONCLUSION: The incidences of cholelithiasis and chole-cystitis do not increased very much after a gastric resection with lymph-node dissection due to gastric cancer, and there are no specific factors affecting those incidences. A prophylactic cholecystectomy during the gastric cancer operation should be performed with caution.