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.

Long-term outcomes of Roux-en-Y and Billroth-I reconstruction after laparoscopic distal gastrectomy

“…No patient in the present study had symptomatic cholecystolithiasis or received treatment for gallstones. In contrast, a previous study reported that cholecystolithiasis developed in 27 % of patients with gallstones after open gastrectomy, and 46 % of these patients received surgical treatment [28]. The reconstruction method of choice after LDG remains controversial.…”

“…Total cholesterol, mean ± SD 0.91 ± 0.16 0.94 ± 0.15 0.34 in another study including patients who underwent open gastrectomy (D1 9.4 %; D2 17.8 %) [28]. Apart from the passage of food through the duodenum, destruction of the vagus nerve is also an important risk factor for gallstone formation [29] and such destruction was marked in patients who had undergone extensive lymph node dissection.…”

Factors for Postoperative Gallstone Occurrence in Patients with Gastric Cancer: a Meta-analysis

“…According to the inclusion and exclusion criteria, we rejected the literature which didn't fit criterion, then 15 literatures (Mizuta et al, 1990;Pezzolla et al, 1993;Kodama et al, 1995;Wu et al, 1995;Hidetoshi et al, 1998;Furukawa et al, 1999;Shibata et al, 2004;Tomita et al, 2004;Akatsu et al, 2005;Kobayashi et al, 2005;Yoo et al, 2005;Nunobe et al, 2007;Kojima et al, 2008;Fukagawa et al, 2009;Sun et al, 2011) were included into this study, including 3 RCT articles, 5 cohort study articles and 7 case-control study articles. The number of cases is from 32 to 893 in the 15 articles.…”

The Cholegas Study: safety of prophylactic cholecystectomy during gastrectomy for cancer: preliminary results of a multicentric randomized clinical trial

“…Many studies reported a three-four fold increased incidence 5 years after gastric surgery (up to 15-25 %) [1][2][3][4][5][6] with an estimated mean value of 17 % in all studies [1][2][3][4][5][6][7]. The underlying mechanism was thought to be related to surgical dissection of the vagus nerve branches and the anatomical gastrointestinal reconstruction [5,[8][9][10], and to the extent of gastrectomy and lymphadenectomy [1,4,[11][12][13].…”