Individualized Choice of Simultaneous Cholecystectomy in Patients with Gastric Cancer: A Systematic Review and Meta-analysis.

Background: Patients undergoing gastrectomy for gastric cancer are more likely to develop gallstones than the general population. Prophylactic cholecystectomy remains controversial.

Methods: Studies from 2000-2022 were systematically searched in the PubMed, EMBASE, and Cochrane Library databases. The search included simultaneous cholecystectomy or risk factors for gallstone formation with gastrectomy alone. Major prognostic factors included complications and mortality, and risk factor analyses included age, sex, TNM stage, gastrectomy type, lymph node dissection, diabetes, and duodenal exclusion. Random effects regression models were used to analyze risk estimates and data were presented as odds ratios (ORs) with corresponding 95% confidence intervals (CIs).

Results: There were no significant differences in postoperative morbidity (OR 1.12, 95% CI 0.90-1.39; p = 0.33, I = 11%) and mortality (OR 1.23, 95% CI 0.62-2.43; p = 0.56, I = 0%) between gastrectomy alone and simultaneous cholecystectomy. Older age (OR 1.48, 95% CI 1.36-1.59; p < 0.001, I = 59%), male sex (OR 1.38, 95% CI 1.10-1.71; p = 0.004, I = 77%), total gastrectomy (OR 1.50, 95% CI 1.25-1.81; p < 0.001, I = 72%), diabetes mellitus (OR 1.38, 95% CI 1.17-1.63; p < 0.001, I = 8%), and duodenal exclusion (OR 1.77, 95% CI 1.47-2.15; p < 0.001, I = 30%) were risk factors for cholecystolithiasis.

Conclusions: Simultaneous cholecystectomy did not increase the incidence of postoperative complications or mortality. Older age, male sex, total gastrectomy, duodenal exclusion, and diabetes were risk factors for gallstone development after gastrectomy.