Cholelithiasis and cholecystitis after gastrectomy for gastric carcinoma: a comparison of lymphadenectomy of varying extent.

BACKGROUND/AIMS: The complications of cholelithiasis and cholecystitis after gastrectomy for gastric carcinoma were reviewed.

PATIENTS AND METHODS: Between 1983 and 1988, 474 patients with a normal gallbladder received gastrectomy for gastric cancer.

RESULTS: Among the 288 patients who underwent radical gastrectomy with systematic lymphadenectomy (RG), 9 (3.1%) were suffering from acute postoperative acalculous cholecystitis, and 2 of them died. None of the 186 patients treated with simple gastrectomy (SG) developed this complication (RG vs. SG, p <0.05). The long-term prognosis of RG is better than that of SG. However, as of July 1993, of among the 463 patients with a normal gallbladder who survived the operation, 85 of the 281 patients who underwent RG and 9 of the 182 patients who underwent SG had gallstones (RG vs. SG, P<0.001). Of the cases complicated by postgastrectomy cholelithiasis, the mean interval between gastrectomy and gallstone formation was shorter in the RG patients (31.4 +/- 20.9 months) than in the SG patients (48.0 +/- 12.8 months) (P<0.05). Following gallstone formation, there was a higher rate of acute biliary symptoms in patients who underwent RG.

CONCLUSIONS: Early cholecystectomy should be performed in patients who received an RG with gallstone formation. Moreover, it would be better to include a policy of prophylactic cholecystectomy in the procedures of RG, even if the gallbladder is normal, in order to prevent the complications of acute cholecystitis and cholelithiasis.