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Hanna DN, Khajoueinejad N, Ghani MO, Hermina A, Mina A, Bailey CE, Cohen N, Labow D, Golas B, Sarpel U, Idrees K, Magge D. Prophylactic Cholecystectomy is Safe in Patients Undergoing Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy. Am Surg 2024; 90:1577-1581. [PMID: 38587264 DOI: 10.1177/00031348241246171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
BACKGROUND While cholecystectomy is one of the most common operations performed in the United States, there is a continued debate regarding its prophylactic role in elective surgery. Particularly among patients with peritoneal carcinomatosis who undergo cytoreduction surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC), further abdominal operations may pose increasing morbidity due to intraabdominal adhesions and potential recurrence. This bi-institutional retrospective study aims to assess postoperative morbidity associated with prophylactic cholecystectomy at the time of CRS-HIPEC. METHODS We performed a bi-institutional retrospective analysis of 578 patients who underwent CRS-HIPEC from 2011 to 2021. Postoperative outcomes among patients who underwent prophylactic cholecystectomy at the time of CRS-HIPEC were compared to patients who did not, particularly rate of bile leak, hospital length of stay, rate of Clavien-Dindo classification morbidity grade III or greater, and number of hospital re-admissions within 30 days. RESULTS Of the 535 patients available for analysis, 206 patients (38.3%) underwent a prophylactic cholecystectomy. Of the 3 bile leaks (1.5%) that occurred among patients who underwent prophylactic cholecystectomy, all 3 occurred in patients who underwent a concomitant liver resection. There were no significant differences in hospital length of stay, postoperative morbidity, and number of hospital re-admissions among patients who underwent prophylactic cholecystectomy compared to those who did not. CONCLUSION Prophylactic cholecystectomy in patients undergoing CRS-HIPEC is not associated with increased morbidity or increased bile leak risk compared to historical data. While the benefits of prophylactic cholecystectomy are not yet elucidated, it may be considered to avoid potential future morbid operations for biliary disease.
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Affiliation(s)
- David N Hanna
- Section of Surgical Sciences, Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nazanin Khajoueinejad
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai University, New York City, NY, USA
| | - Muhammad O Ghani
- Section of Surgical Sciences, Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Andrew Hermina
- Section of Surgical Sciences, Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alexander Mina
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Christina E Bailey
- Section of Surgical Sciences, Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Noah Cohen
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai University, New York City, NY, USA
| | - Daniel Labow
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai University, New York City, NY, USA
| | - Benjamin Golas
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai University, New York City, NY, USA
| | - Umut Sarpel
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai University, New York City, NY, USA
| | - Kamran Idrees
- Section of Surgical Sciences, Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Deepa Magge
- Section of Surgical Sciences, Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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Son JH, Dong SR, Kim J, Kim J, Kong TW, Chang SJ. Significance of cholecystectomy in cytoreductive surgery for advanced ovarian cancer. BMC Surg 2023; 23:60. [PMID: 36941661 PMCID: PMC10026427 DOI: 10.1186/s12893-023-01956-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 02/23/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND There have been no studies concerning the complications or benefits of cholecystectomy in ovarian cancer. In this study, we aimed to evaluate the outcomes of cholecystectomy performed during various time periods of the disease course and suggest a management strategy for cholecystectomy in ovarian cancer. METHODS We retrospectively reviewed the medical records of patients with advanced ovarian cancer who underwent cholecystectomy during the cytoreductive surgery from 2009 to 2020. Cholecystectomy was primarily indicated when the gallbladder and surrounding structures were considered to have metastatic tumor invasion. If the final pathologic results showed free of malignant tumor, patients were placed into the no-infiltration group. Clinical outcomes including the recurrence rate and complications were analyzed. RESULTS A total of 62 patients underwent cholecystectomy, 48 of whom (77.4%) underwent cholecystectomy during primary or interval debulking surgery, whereas 14 (22.6%) underwent cholecystectomy during the follow-up period (five with benign disease and 9 with disease recurrence). Among the patients, 32 (51.6%) patients were included in the no-infiltration group in the final pathology. There were no complications observed in the no-infiltration group (n = 32). Seven (78%) of the nine patients who received cholecystectomy for disease recurrence had metastatic disease in the porta-hepatis or lesser sac at the time of primary surgery. However, no recurrent lesions were observed around the porta-hepatis in patients who received cholecystectomy during primary treatment. CONCLUSION Considering the safety of the procedure, as well as the risk of disease recurrence or cholecystitis, a cholecystectomy can be offered to patients with ovarian cancer who have metastatic lesions around the gallbladder and porta-hepatis at the time of primary surgery.
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Affiliation(s)
- Joo-Hyuk Son
- Department of Obstetrics and Gynecology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, 16499, Suwon, Republic of Korea
| | - Su Ryeon Dong
- Department of Obstetrics and Gynecology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, 16499, Suwon, Republic of Korea
| | - Jisoo Kim
- Department of Obstetrics and Gynecology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, 16499, Suwon, Republic of Korea
| | - Jeeyeon Kim
- Department of Obstetrics and Gynecology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, 16499, Suwon, Republic of Korea
| | - Tae-Wook Kong
- Department of Obstetrics and Gynecology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, 16499, Suwon, Republic of Korea
| | - Suk-Joon Chang
- Department of Obstetrics and Gynecology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, 16499, Suwon, Republic of Korea.
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Liu H, Liu J, Xu W, Chen X. Prophylactic cholecystectomy: A valuable treatment strategy for cholecystolithiasis after gastric cancer surgery. Front Oncol 2022; 12:897853. [PMID: 36176409 PMCID: PMC9513465 DOI: 10.3389/fonc.2022.897853] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 08/23/2022] [Indexed: 11/24/2022] Open
Abstract
The main treatment for gastric cancer is surgical excision. Gallstones are one of the common postoperative complications of gastric cancer. To avoid the adverse effects of gallstone formation after gastric cancer surgery, we reviewed the causes and risk factors and mechanisms involved in gallstone formation after gastric cancer surgery. The evidence and value regarding prophylactic cholecystectomy (PC) during gastric cancer surgery was also reviewed. Based on previous evidence, we summarized the mechanism and believe that injury or resection of the vagus nerve or changes in intestinal hormone secretion can lead to physiological dysfunction of the gallbladder and Oddi sphincter, and the lithogenic components in the bile are also changed, ultimately leading to CL. Previous studies also have identified many independent risk factors for CL after gastric cancer, such as type of gastrectomy, reconstruction of the digestive tract, degree of lymph node dissection, weight, liver function, sex, age, diabetes and gallbladder volume are closely related to CL development. At present, there are no uniform guidelines for the selection of treatment strategies. As a new treatment strategy, PC has undeniable advantages and is expected to become the standard treatment for CL after gastric cancer in the future. The individualized PC strategy for CL after gastric cancer is the main direction of future research.
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Affiliation(s)
- Haipeng Liu
- Department of General Surgery, Lanzhou University Second Hospital, Lanzhou, China
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
- Key Laboratory of Digestive System Tumors of Gansu Province, Lanzhou University Second Hospital, Lanzhou, China
- *Correspondence: Haipeng Liu,
| | - Jie Liu
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
- Key Laboratory of Digestive System Tumors of Gansu Province, Lanzhou University Second Hospital, Lanzhou, China
| | - Wei Xu
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
- Key Laboratory of Digestive System Tumors of Gansu Province, Lanzhou University Second Hospital, Lanzhou, China
| | - Xiao Chen
- Department of General Surgery, Lanzhou University Second Hospital, Lanzhou, China
- The Second Clinical Medical College, Lanzhou University, Lanzhou, China
- Key Laboratory of Digestive System Tumors of Gansu Province, Lanzhou University Second Hospital, Lanzhou, China
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Georgescu D, Caraba A, Ionita I, Lascu A, Hut EF, Dragan S, Ancusa OE, Suceava I, Lighezan D. Dyspepsia and Gut Microbiota in Female Patients with Postcholecystectomy Syndrome. Int J Womens Health 2022; 14:41-56. [PMID: 35136356 PMCID: PMC8816732 DOI: 10.2147/ijwh.s342882] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/06/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Gallstone disease (GSD) represents one of the most frequent digestive disorders, highly reported in female gender. The purpose of the study was to explore the clinical and gut microbiota particularities of female patients with postcholecystectomy syndrome (PCS) and the possible relationship between gut dysbiosis (DB) and abdominal complaints. PATIENTS AND METHODS In total, 129 female participants: 104 outpatients divided into two equal groups, 52 PCS (+), 52 PCS (-) and 25 healthy controls were consecutively enrolled in this observational study. Patients underwent clinical examination with assessment of pain, bloating, transit disturbances, abdominal ultrasound/computer tomography/magnetic resonance imaging/endoscopic retrograde cholangiopancreatography, upper and lower digestive endoscopies. Laboratory work-ups and stool microbiology assessments were performed for all study participants (patients and controls). Stool microorganisms were identified by matrix-assisted laser desorption ionization - time-of-flight- mass spectrometry and in patients with DB also by next-generation sequencing. RESULTS Older age, complicated gallstones disease, associated conditions like diabetes mellitus/impaired glucose tolerance and irritable bowel syndrome were significantly present in PCS (+) group, as well as sedentary lifestyle and diets characterized by a low fiber intake (p<0.0001). PCS (+) patients displayed significant differences related to the incidence and severity of overall gut microbiota DB, decreased H index of biodiversity and the unbalanced Firmicutes/Bacteroidetes (F/B) ratios by comparison to the PCS (-) group (p<0.0001). Strong positive correlations of the severity of overall DB with bloating and the intestinal habit disorders, as well as of F/B ratios to all abdominal symptoms were noted. CONCLUSION PCS in female patients was associated with older age, sedentary lifestyle, specific dietary habits, history of complicated gallstone disease, diabetes mellitus/impaired glucose tolerance and irritable bowel syndrome, as well as gut microbiota particularities. Overall DB and unbalanced F/B ratios were strongly correlated to abdominal complaints.
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Affiliation(s)
- Doina Georgescu
- Department of Internal Medicine I, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Alexandru Caraba
- Department of Internal Medicine I, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Ioana Ionita
- Department of Internal Medicine I, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Ana Lascu
- Department of Functional Sciences, Discipline of Pathophysiology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Emil Florin Hut
- Department IX of Surgery I/Compartment of Hepato-Bilio-Pancreatic Surgery, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Simona Dragan
- Department of Cardiology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Oana Elena Ancusa
- Department of Internal Medicine I, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Ioana Suceava
- Department of Internal Medicine I, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Daniel Lighezan
- Department of Internal Medicine I, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
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Koutroumpakis F, Lodhi M, Ahsan M, Ramos Rivers C, Schwartz M, Hashash JG, Babichenko D, Tang G, Nagpal T, Dunn M, Keshavarzian A, Binion DG. The Impact of Cholecystectomy on Long-Term Disease Outcomes and Quality of Life in Patients with Crohn's Disease. Inflamm Bowel Dis 2021; 27:336-343. [PMID: 32313925 DOI: 10.1093/ibd/izaa076] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Cholecystectomy (CCY) is one of the most frequently performed abdominal surgeries. However, the impact of CCY in clinical settings with altered gastrointestinal physiology and anatomy, such as Crohn's disease (CD), has not been fully characterized. We sought to investigate clinical outcomes, disease severity, and quality of life of CD patients after CCY. METHODS We utilized a prospective, longitudinal registry of consented CD patients followed at a tertiary center. Crohn's disease patients that had or had not undergone CCY formed the 2 study groups. The absence or presence of gallbladder was confirmed with abdominal CT scans obtained during routine care. Multiyear clinical, biochemical, and histologic data were collected and analyzed. RESULTS Among 834 CD patients, 151 (18%) had undergone CCY. History of CCY was associated with higher disease activity (median Harvey-Bradshaw index; P < 0.001), more years with anemia (P = 0.048), lower albumin (P = 0.001), worse quality of life (mean Short Inflammatory Bowel Disease Questionnaire; P < 0.001), chronic abdominal pain (P < 0.001), higher risk for incident colonic dysplasia (P = 0.011), higher rates of annual hospital admissions (P = 0.004), and opioid use (P < 0.001). In multivariate analysis, CCY remained associated with higher disease activity (P < 0.001), lower albumin (P = 0.008), lower quality of life (P < 0.001), and more hospital admissions (P = 0.008), whereas CD patients with diseased ileum had higher risk for colonic dysplasia (P = 0.031). CONCLUSIONS CCY in CD patients was associated with multiple markers of disease activity and worse quality of life during multiyear follow up. This data suggests that CCY in CD patients may adversely impact the long-term clinical course.
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Affiliation(s)
- Filippos Koutroumpakis
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Maham Lodhi
- Department of Medicine, Division of Gastroenterology and Hepatology, Rush University Medical Center, Illinois, USA
| | - Maaz Ahsan
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Claudia Ramos Rivers
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Marc Schwartz
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jana G Hashash
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Dmitriy Babichenko
- School of Information Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Gong Tang
- School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tanvi Nagpal
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Michael Dunn
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ali Keshavarzian
- Department of Medicine, Division of Gastroenterology and Hepatology, Rush University Medical Center, Illinois, USA
| | - David G Binion
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Elgohary H, El Azawy M, Elbanna M, Elhossainy H, Omar W. Concomitant versus Delayed Cholecystectomy in Bariatric Surgery. J Obes 2021; 2021:9957834. [PMID: 34234964 PMCID: PMC8216831 DOI: 10.1155/2021/9957834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 06/01/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Obesity and weight loss after bariatric surgery have a close association with gallbladder disease. The performance and proper timing of laparoscopic cholecystectomy (LC) with bariatric surgery remain a clinical question. OBJECTIVE Evaluation of the outcome of LC during bariatric surgery whether done concomitantly or delayed according to the level of intraoperative difficulty. METHODS The prospective study included patients with morbid obesity between December 2018 and December 2019 with preoperatively detected gallbladder stones. According to the level of difficulty, patients were allocated into 2 groups: group 1 included patients who underwent concomitant LC during bariatric surgery, and group 2 included patients who underwent delayed LC after 2 months. In group 1, patients were further divided into subgroups: LC either at the beginning (subgroup A) or after bariatric surgery (subgroup B). RESULTS Operative time in group 1 vs. 2 was 92.63 ± 28.25 vs. 68.33 ± 17.49 (p < 0.001), and in subgroup A vs. B, it was 84.19 ± 19.62 vs. 130.0 ± 31.62 (p < 0.001). One patient in each group (2.6% and 8.3%) had obstructive jaundice, p > 0.001. In group 2, 33% of asymptomatic patients became symptomatic for biliary colic p > 0.001. LC difficulty score was 2.11 ± 0.70 vs. 5.66 ± 0.98 in groups 1 and 2, respectively, p < 0.001. LC difficulty score decreased in group 2 from 5.66 ± 0.98 to 2.26 ± 0.78 after 2 months of bariatric surgery, p < 0.001. CONCLUSION Timing for LC during bariatric surgery is challenging and should be optimized for each patient as scheduling difficult LC to be performed after 2 months may be an option.
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Affiliation(s)
- Hatem Elgohary
- General Surgery Department, Faculty of Medicine, Helwan University, Helwan, Egypt
| | - Mahmoud El Azawy
- General Surgery Department, Faculty of Medicine, Helwan University, Helwan, Egypt
| | - Mohey Elbanna
- Department of General Surgery, Faculty of Medicine, Ain-shams University, Cairo, Egypt
| | - Hossam Elhossainy
- General Surgery Department, Faculty of Medicine, Helwan University, Helwan, Egypt
| | - Wael Omar
- General Surgery Department, Faculty of Medicine, Helwan University, Helwan, Egypt
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Cavallin F, Scarpa M, Cagol M, Alfieri R, Ruol A, Chiarion Sileni V, Rugge M, Ancona E, Castoro C. Cholecystectomy during esophagectomy is safe but unnecessary. Acta Chir Belg 2020; 120:35-41. [PMID: 30618322 DOI: 10.1080/00015458.2018.1554364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Prophylactic cholecystectomy has been proposed as a concomitant procedure during upper gastrointestinal surgery. This study evaluates the safety and the need of concurrent cholecystectomy during esophagectomy for cancer.Methods: All consecutive esophagectomies for esophageal cancer at the Center for Esophageal Diseases in Padova (Italy) between 1992 and 2011 were included. The safety of concurrent cholecystectomy was evaluated by surgical outcomes (length of stay, postoperative mortality and perioperative complications). The need for concurrent cholecystectomy was evaluated by occurrence of biliary duct stones and of cholelithiasis/cholecystitis after esophagectomy.Results: Cholecystectomy was performed during 67 out of 1087 esophagectomies (6.2%). Cirrhosis or chronic liver disease was associated with receiving cholecystectomy during esophagectomy (OR: 1.99, 95%C.I. 1.10-3.56). Patients receiving and those not receiving cholecystectomy showed similar length of stay (median 14 days, p = .87), postoperative mortality (3.0% vs. 2.5%, p = .68), intraoperative complication (4.5% vs. 7.1%, p = .62), early complications (52.2% vs. 44.6%, p = .25) and late complications (20.9% vs. 24.8%, p = .56). Cholelithiasis/cholecystitis after esophagectomy occurred in 61 (6.1%) patients, with only four requiring cholecystectomy during follow-up. The biliary stone occurrence was nil. Only pathologic stage III-IV (OR: 2.17, 95%C.I. 1.19-3.96) was associated with cholelithiasis/cholecystitis after esophagectomy.Conclusion: Routine prophylactic cholecystectomy during esophagectomy could be safe but unnecessary.
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Affiliation(s)
- Francesco Cavallin
- Surgical Oncology Unit, Veneto Institute of Oncology IOV IRCCS, Padova, Italy
| | - Marco Scarpa
- Surgical Oncology Unit, Veneto Institute of Oncology IOV IRCCS, Padova, Italy
| | - Matteo Cagol
- Surgical Oncology Unit, Veneto Institute of Oncology IOV IRCCS, Padova, Italy
| | - Rita Alfieri
- Surgical Oncology Unit, Veneto Institute of Oncology IOV IRCCS, Padova, Italy
| | - Alberto Ruol
- Clinica Chirurgica 3, Dipartimento di Scienze Chirurgiche Oncologiche e Gastroenterologiche DiSCOG, Azienda Ospedaliera-Università di Padova, Padova, Italy
| | | | - Massimo Rugge
- Department of Medicine (DIMED), Università di Padova, Padova, Italy
| | - Ermanno Ancona
- Surgical Oncology Unit, Veneto Institute of Oncology IOV IRCCS, Padova, Italy
| | - Carlo Castoro
- Department of upper GI surgery, Humanitas Research Hospital - Humanitas University, Rozzano (Milano), Italy
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Leyva-Alvizo A, Arredondo-Saldaña G, Leal-Isla-Flores V, Romanelli J, Sudan R, Gibbs KE, Petrick A, Soriano IS. Systematic review of management of gallbladder disease in patients undergoing minimally invasive bariatric surgery. Surg Obes Relat Dis 2019; 16:158-164. [PMID: 31839526 DOI: 10.1016/j.soard.2019.10.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 10/16/2019] [Accepted: 10/18/2019] [Indexed: 12/24/2022]
Abstract
The introduction and subsequent widespread adaptation of minimally invasive approaches for bariatric surgery have not only changed the outcomes of bariatric surgery but also called into question the management of co-morbid surgical conditions, in particular gallbladder disease. The American Society for Metabolic and Bariatric Surgery Foregut Committee performed a systematic review of the published literature from 1995-2018 on management of gallbladder disease in patients undergoing bariatric surgery. The papers reviewed generated the following results. (1) Routine prophylactic cholecystectomy at the time of bariatric surgery is not recommended. (2) In symptomatic patients who are undergoing bariatric surgery, concomitant cholecystectomy is acceptable and safe. (3) Ursodeoxycholic acid may be considered for gallstone formation prophylaxis during the period of rapid weight loss. (4) Routine preoperative screening and postoperative surveillance ultrasound is not recommended in asymptomatic patients. In the era of minimally invasive surgery, the management of gallbladder disease in patients undergoing bariatric surgery continues to evolve.
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Affiliation(s)
- Adolfo Leyva-Alvizo
- Tecnológico de Monterrey, Escuela de Medicina, Monterrey, Nuevo Leon, Mexico
| | | | | | - John Romanelli
- University of Massachusetts Medical School, Baystate Medical Center, Springfield, Massachusetts
| | - Ranjan Sudan
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Karen E Gibbs
- Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, Staten Island University Hospital, Staten Island, New York
| | | | - Ian S Soriano
- University of Pennsylvania Perelman School of Medicine, Pennsylvania Hospital, Philadelphia, Pennsylvania.
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Tan Z, Xie P, Qian H, Yao X. Clinical analysis of prophylactic cholecystectomy during gastrectomy for gastric cancer patients: a retrospective study of 1753 patients. BMC Surg 2019; 19:48. [PMID: 31088424 PMCID: PMC6515595 DOI: 10.1186/s12893-019-0512-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 05/03/2019] [Indexed: 11/10/2022] Open
Abstract
Background Performance of gastrectomy in gastric cancer patients can lead to an increased incidence of cholecystolithiasis (CL) and a higher morbidity rate. However, the value of prophylactic cholecystectomy performed during gastric cancer surgery is still being debated. Methods We carried out a retrospective study on patients with gastric cancer who underwent subtotal or total gastrectomy, with preservation of the gallbladder or simultaneous cholecystectomy from January 2010 to March 2018. Results Cholecystolithiasis occurred in 152 of 1691 (8.98%) patients after gastric cancer surgery, with 45 (2.67%) patients undergoing subsequent cholecystectomy. Postoperative body mass index (BMI) decrease > 5% in 3 months was an independent risk factor for cholecystolithiasis [BMI decrease > 5%/≤5%: OR (95%CI): 1.812 (1.225–2.681), p = 0.003). Gastrectomy method and diabetes mellitus were independent risk factors for both cholecystolithiasis [gastrectomy method (no-Billroth I/Billroth I): OR (95%CI): 1.801 (1.097–2.959), p = 0.002; diabetes mellitus (yes/no): OR (95%CI): 1.544 (1.030–2.316), p = 0.036] and subsequent cholecystectomy [gastrectomy method (no-Billroth I/Billroth I): OR (95%CI): 5.432 (1.309–22.539), p = 0.020; diabetes mellitus (yes/no): OR (95%CI): 2.136 (1.106–4.125), p = 0.024]. Simultaneous cholecystectomy was performed in 62 of 1753 (3.5%) patients. The mortality and morbidity rates did not differ significantly between the combined surgery group and the gastrectomy only group (8.1% vs. 8.9 and 1.6% vs. 2.2%, respectively, p > 0.05). Conclusions Prophylactic cholecystectomy may be necessary in gastric cancer patients without Billroth I gastrectomy and with diabetes mellitus. Simultaneous cholecystectomy during gastric cancer surgery does not increase the postoperative mortality and morbidity rates.
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Affiliation(s)
- Zhenhua Tan
- Department of Hepatobiliary Surgery, Huzhou Hospital, Zhejiang University School of Medicine (Huzhou Central Hospital), No. 198, Hongqi Road, Huzhou, 313000, Zhejiang Province, China
| | - Ping Xie
- Department of Hepatobiliary Surgery, Huzhou Hospital, Zhejiang University School of Medicine (Huzhou Central Hospital), No. 198, Hongqi Road, Huzhou, 313000, Zhejiang Province, China
| | - Hai Qian
- Department of Hepatobiliary Surgery, Huzhou Hospital, Zhejiang University School of Medicine (Huzhou Central Hospital), No. 198, Hongqi Road, Huzhou, 313000, Zhejiang Province, China
| | - Xing Yao
- Department of Hepatobiliary Surgery, Huzhou Hospital, Zhejiang University School of Medicine (Huzhou Central Hospital), No. 198, Hongqi Road, Huzhou, 313000, Zhejiang Province, China.
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10
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Juo YY, Khrucharoen U, Chen Y, Sanaiha Y, Benharash P, Dutson E. Cost analysis and risk factors for interval cholecystectomy after bariatric surgery: a national study. Surg Obes Relat Dis 2018. [DOI: 10.1016/j.soard.2017.11.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Angrisani L, Hasani A, Vitiello A, Santonicola A, Iovino P. Gastric Bypass and Synchronous Cholecystectomy: Not Only Numbers. Obes Surg 2017; 27:2454-2455. [PMID: 28656501 DOI: 10.1007/s11695-017-2775-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Luigi Angrisani
- General and Endoscopic Surgery Unit, San Giovanni Bosco Hospital, P.zza Vittoria 7, Naples, Italy.
| | - Ariola Hasani
- General Surgery, Department of Endocrinology, Gastroenterology and Surgery, University Hospital of Naples "Federico II", Naples, Italy
| | - Antonio Vitiello
- General Surgery, Department of Endocrinology, Gastroenterology and Surgery, University Hospital of Naples "Federico II", Naples, Italy
| | - Antonella Santonicola
- Gastrointestinal Unit, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Paola Iovino
- Gastrointestinal Unit, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
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Lee SY, Jang JH, Kim DW, Park J, Oh HK, Ihn MH, Han HS, Oh JH, Park SJ, Kang SB. Incidental cholecystectomy in patients with asymptomatic gallstones undergoing surgery for colorectal cancer. Dig Surg 2015; 32:183-9. [PMID: 25831966 DOI: 10.1159/000380961] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 02/15/2015] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND AIMS The feasibility of incidental cholecystectomy during colorectal cancer (CRC) surgery has not been determined as yet. We aimed to investigate the feasibility of incidental cholecystectomy during CRC surgery. METHODS The clinicopathologic data of patients who underwent CRC surgery between January 2004 and May 2011 were assessed. Patients with asymptomatic cholelithiasis were divided into groups that did and did not undergo incidental cholecystectomy. Their in-hospital morbidity and long-term biliary complications were compared. RESULTS Of the 282 patients identified, 143 (50.7%) underwent incidental cholecystectomy and 139 (49.3%) were observed without cholecystectomy. The two groups were similar in clinical characteristics, except for gender and operation time. Only one patient (0.7%) in the cholecystectomy group experienced an intraoperative biliary complication. There was no significant difference in overall in-hospital morbidity between the two groups. After a median follow-up period of 33 months, long-term biliary complications developed in 12 patients (8.6%) in the observation group, with 9 undergoing cholecystectomy. CONCLUSIONS Incidental cholecystectomy was not associated with increased postoperative morbidity, whereas previously asymptomatic patients were at substantial long-term risk of becoming symptomatic. Thus, in the absence of clear contraindications, concomitant cholecystectomy might be a desirable treatment option during CRC surgery in patients with asymptomatic gallstones.
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Affiliation(s)
- Soo Young Lee
- Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Korea
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Safety of laparoscopic colorectal surgery in a low-volume setting: review of early and late outcome. Gastroenterol Res Pract 2014; 2014:581523. [PMID: 24799890 PMCID: PMC3996862 DOI: 10.1155/2014/581523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 03/12/2014] [Accepted: 03/13/2014] [Indexed: 02/08/2023] Open
Abstract
Background. There is increasing evidence suggesting that the laparoscopic technique is the treatment of choice for large bowel resection, including for malignancy. The purpose of the study was to assess whether general surgeons, with particular skills in advanced laparoscopy, can adequately provide safe laparoscopic colorectal resections in a low-volume setting. Methods. A retrospective review of prospectively collected case series of all laparoscopic colorectal resections performed under the care of a single general surgeon is presented. The primary endpoint was postoperative clinical outcome in terms of morbidity and mortality. Secondary endpoints were adequacy of surgical margins and number of lymph nodes harvested for colorectal cancer cases. Results. Seventy-three patients underwent 75 laparoscopic resections between March, 2003, and May, 2011. There was no elective mortality and the overall 30-day postoperative morbidity was 9.3%. Conversion and anastomotic leakage rates were both 1.3%, respectively. None of the malignant cases had positive margins and the median number of lymph nodes retrieved was 17. Conclusions. Our results support the view that general surgeons with advanced skills in minimally invasive surgery may safely perform laparoscopic colorectal resection in a low-volume setting in carefully selected patient cases.
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