The Cholegas trial: long-term results of prophylactic cholecystectomy during gastrectomy for cancer—a randomized-controlled trial

Abstract

Background The incidence of cholelithiasis has been shown to be higher for patients after gastrectomy than for the general population, due to vagal branch damage and gastrointestinal reconstruction. The aim of this trial was to evaluate the need for routine concomitant prophylactic cholecystectomy (PC) during gastrectomy for cancer. Methods A multicenter, randomized, controlled trial was conducted between November 2008 and March 2017. Of the total 130 included patients, 65 underwent PC and 65 underwent standard gastric surgery only for curable cancers. The primary endpoint was cholelithiasis-free survival after gastrectomy for gastric adenocarcinoma. Cholelithiasis was detected by ultrasound exam.Results After a median follow-up of 62 months, eight patients (12.3%) in the control group developed biliary abnormalities (four cases of gallbladder calculi and four cases of biliary sludge), with only three (4.6%) being clinically relevant (two cholecystectomies needed, one acute pancreatitis). One patient in the PC group had asymptomatic biliary dilatation during sonography after surgery. The cholelithiasis-free survival did not show statistical significance between the two groups (P = 0.267). The number needed to treat with PC to avoid reoperation for cholelithiasis was 1:32.5. Conclusions Concomitant PC during gastric surgery for malignancies, although reducing the absolute number of biliary abnormalities, has no significant impact on the natural course of patients.

Functional evaluations comparing the double-tract method and the jejunal interposition method following laparoscopic proximal gastrectomy for gastric cancer: an investigation including laparoscopic total gastrectomy

“…At the initial point of this study, the control group had not been determined because of the difference in indications between LPG and L-TG. It became clear that the postoperative QOL was similar between L-DT and L-JIP, and some researchers have reported that there were few significant differences in the postoperative QOL between total and proximal gastrectomy [ 14 , 15 ].…”

The Effect Of Lymph Node Dissection On Gallstone Formation in Patients Undergoing Total Gastrectomy For Gastric Adenocarcinoma

“…Many authors recommend performing cholecystectomy simultaneously with gastric cancer surgery for existing gallbladder stones due to concerns about postoperative acute cholecystitis due to gallbladder disease (2,14). In our series, cholecystectomy was performed in 5.9% of patients because of gallbladder disease discovered during gastrectomy, and we did not encounter any complications related to cholecystectomy in these patients.…”

Ursodeoxycholic acid for the prevention of gallstone and subsequent cholecystectomy following gastric surgery: A systematic review and meta‐analysis

“…20 A recent RCT of PC for gastric cancer patients showed that a concomitant PC done during gastric surgery for malignancies is safe and without technical difficulties. 19,53 But the overall postsurgical morbidities of laparoscopic cholecystectomy, including wound infection, bile duct injury, bile leakage, and open conversion are still not negligible. 54 The history of upper abdominal surgery is known as being a risk factor for open conversion of cholecystectomy, 55 although abdominal surgical history is not a risk factor for difficult laparoscopic cholecystectomy for the experienced surgeon.…”

“…Various studies have reported on the prophylactic effectiveness of UDCA to reduce gallstone formation following gastric surgery in obese patients. [16][17][18][19] Recently, a randomized controlled study (RCT) reported that the results of UDCA administration significantly reduced the incidence of gallstones following gastrectomy for gastric cancer. 20 UDCA is not burdensome to use for prophylactic purpose because it is a well-known, long-term use drug with few severe adverse events.…”