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Gastric Cancer. 2019 May;22(3):632-639. doi: 10.1007/s10120-018-0879-x. Epub 2018 Sep 22.

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

Author information

1
Division of Oncologic Surgery and Robotics, Department of Oncology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy. lapbenc@tin.it.
2
Department of Surgery, University Hospital, Padua, Italy.
3
Digestive Surgery of University Hospital "A. Gemelli", Rome, Italy.
4
Unit of Epidemiology and Medical Statistics, University of Verona, Verona, Italy.
5
Department of Surgery, University of Siena, Siena, Italy.
6
Surgical Oncology Catholic University, Campobasso, Italy.
7
General Surgery, "C. Poma" Hospital, Pieve di Coriano, Mantua, Italy.
8
General Surgery, Careggi University Hospital, Florence, Italy.
9
Division of Oncologic Surgery and Robotics, Department of Oncology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy.

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 (Pā€‰=ā€‰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.

KEYWORDS:

Gastric cancer; Gastric surgery; Prophylactic cholecystectomy

PMID:
30244294
DOI:
10.1007/s10120-018-0879-x

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