Esswein Katharina, Gehwolf Philipp, Wykypiel Heinz, Kafka-Ritsch Reinhold
Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria.
Langenbecks Arch Surg. 2024 Feb 10;409(1):57. doi: 10.1007/s00423-024-03242-x.
Gallstone formation is increased after gastric (GR) or esophageal resection (ER); however, the exact pathophysiology is not fully understood yet. Symptomatic cholecystolithiasis and the need for subsequent cholecystectomy after upper gastrointestinal resection can alter the outcome in oncological patients. There is an ongoing discussion if these patients benefit from a simultaneous prophylactic cholecystectomy. This study aims to analyze the risk of gallstone formation after GR or ER and the perioperative course of a subsequent cholecystectomy.
In this study, all patients were included, who underwent an oncological gastric or esophageal resection at the Medical University of Innsbruck, Department of Visceral, Transplant and Thoracic Surgery in the years 2003-2021.
A simultaneous cholecystectomy was performed in 29.8% with GR and in 2.1% with ER (p < 0.001). There was no significant difference in complications or length-of-stay between patients with simultaneous vs. no simultaneous cholecystectomy. Newly developed gallstones tended to be more common after GR (16% vs. 10% ER), after reconstruction without preservation of the duodenal passage (17% vs. 11% with) and after GR with lymph node dissection (19% vs. 5% without). After ER, subsequent cholecystectomy was significant less frequently (11.4% vs. 2.9% OR) (p = 0.005). The subsequent cholecystectomy was performed openly in 57.1% with major complications classified as Clavien-Dindo ≥ 3a in 14.3%.
Based on the findings of our study, we do not recommend simultaneous cholecystectomy routinely in oncological gastric or esophageal resections. An individualized approach depending on risk factors like extensive lymphadenectomy or duodenal passage can be discussed.
胃切除术（GR）或食管切除术后（ER）胆结石形成增加；然而，确切的病理生理学尚未完全明确。有症状的胆囊结石以及上消化道切除术后后续行胆囊切除术的必要性会改变肿瘤患者的预后。对于这些患者是否从同期预防性胆囊切除术中获益仍存在讨论。本研究旨在分析GR或ER后胆结石形成的风险以及后续胆囊切除术的围手术期过程。
本研究纳入了2003年至2021年在因斯布鲁克医科大学内脏、移植和胸外科接受肿瘤性胃或食管切除术的所有患者。
GR患者中29.8%同期行胆囊切除术，ER患者中2.1%同期行胆囊切除术（p<0.001）。同期行胆囊切除术与未同期行胆囊切除术的患者在并发症或住院时间方面无显著差异。GR后新发胆结石更常见（16%对ER的10%），十二指肠通道未保留的重建术后（17%对保留的11%）以及GR联合淋巴结清扫术后（19%对未清扫的5%）。ER后，后续胆囊切除术的频率显著更低（11.4%对2.9%，OR）（p=0.005）。后续胆囊切除术57.1%为开放手术，14.3%的主要并发症分类为Clavien-Dindo≥3a。
基于我们的研究结果，我们不建议在肿瘤性胃或食管切除术中常规同期行胆囊切除术。可以讨论根据广泛淋巴结清扫或十二指肠通道等风险因素采取个体化方法。
