A comparison of short-term postoperative outcomes including nutritional status between gastrectomy with simultaneous cholecystectomy and gastrectomy only in patients with gastric cancer
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摘要
Objective: We aimed to evaluate the effect of simultaneous cholecystectomy on the short-term postoperative outcomes and nutritional status in patients with gastric cancer.Methods: We retrospectively reviewed data from 4,820 patients with gastric cancer who underwent gastrectomy from January 2011 to December 2016. Patients who underwent only gastrectomy(N=4,578) were matched to those who underwent simultaneous cholecystectomy during gastrectomy(N=242) at a 1:1 ratio using propensity score matching analysis. The nutritional status and inflammatory responses preoperatively and postoperatively and postoperative outcomes were compared between the groups.Results: The simultaneous cholecystectomy group showed more intraoperative blood loss and a longer operative time than the gastrectomy only group [150.0(100.0, 200.0) m L vs. 100.0(100.0, 200.0) m L, P=0.006; 176.0(150.0,210.0) min vs. 155.0(128.0, 188.0) min, P<0.001, respectively]. Intraoperative event rate, postoperative complication rate, and postoperative recovery did not differ between the groups. All parameters including body weight, the hemoglobin level, absolute lymphocyte count, total protein level, albumin level, fasting glucose level,and prognostic nutritional index excluding the cholesterol level were not significantly different between the groups,and their changing patterns were similar. Although the cholesterol level was significantly lower in the simultaneous cholecystectomy group than in the gastrectomy only group at all follow-up points, the mean value of the decreased cholesterol level was within normal range.Conclusions: In gastric cancer patients with gallbladder disease, simultaneous cholecystectomy is safe and not associated with additional nutritional loss.
Objective: We aimed to evaluate the effect of simultaneous cholecystectomy on the short-term postoperative outcomes and nutritional status in patients with gastric cancer.Methods: We retrospectively reviewed data from 4,820 patients with gastric cancer who underwent gastrectomy from January 2011 to December 2016. Patients who underwent only gastrectomy(N=4,578) were matched to those who underwent simultaneous cholecystectomy during gastrectomy(N=242) at a 1:1 ratio using propensity score matching analysis. The nutritional status and inflammatory responses preoperatively and postoperatively and postoperative outcomes were compared between the groups.Results: The simultaneous cholecystectomy group showed more intraoperative blood loss and a longer operative time than the gastrectomy only group [150.0(100.0, 200.0) m L vs. 100.0(100.0, 200.0) m L, P=0.006; 176.0(150.0,210.0) min vs. 155.0(128.0, 188.0) min, P<0.001, respectively]. Intraoperative event rate, postoperative complication rate, and postoperative recovery did not differ between the groups. All parameters including body weight, the hemoglobin level, absolute lymphocyte count, total protein level, albumin level, fasting glucose level,and prognostic nutritional index excluding the cholesterol level were not significantly different between the groups,and their changing patterns were similar. Although the cholesterol level was significantly lower in the simultaneous cholecystectomy group than in the gastrectomy only group at all follow-up points, the mean value of the decreased cholesterol level was within normal range.Conclusions: In gastric cancer patients with gallbladder disease, simultaneous cholecystectomy is safe and not associated with additional nutritional loss.
Objective: We aimed to evaluate the effect of simultaneous cholecystectomy on the short-term postoperative outcomes and nutritional status in patients with gastric cancer.Methods: We retrospectively reviewed data from 4,820 patients with gastric cancer who underwent gastrectomy from January 2011 to December 2016. Patients who underwent only gastrectomy(N=4,578) were matched to those who underwent simultaneous cholecystectomy during gastrectomy(N=242) at a 1:1 ratio using propensity score matching analysis. The nutritional status and inflammatory responses preoperatively and postoperatively and postoperative outcomes were compared between the groups.Results: The simultaneous cholecystectomy group showed more intraoperative blood loss and a longer operative time than the gastrectomy only group [150.0(100.0, 200.0) m L vs. 100.0(100.0, 200.0) m L, P=0.006; 176.0(150.0,210.0) min vs. 155.0(128.0, 188.0) min, P<0.001, respectively]. Intraoperative event rate, postoperative complication rate, and postoperative recovery did not differ between the groups. All parameters including body weight, the hemoglobin level, absolute lymphocyte count, total protein level, albumin level, fasting glucose level,and prognostic nutritional index excluding the cholesterol level were not significantly different between the groups,and their changing patterns were similar. Although the cholesterol level was significantly lower in the simultaneous cholecystectomy group than in the gastrectomy only group at all follow-up points, the mean value of the decreased cholesterol level was within normal range.Conclusions: In gastric cancer patients with gallbladder disease, simultaneous cholecystectomy is safe and not associated with additional nutritional loss.
引文
1.Eom BW, Kim J, Kim DH, et al. Recovery of food intake after gastrectomy for gastric cancer:Based on a large-scale gastric cancer cohort. Dig Surg 2018;35:220-9.
2 .Shim H, Cheong JH, Lee KY, et al. Perioperative nutritional status changes in gastrointestinal cancer patients. Yonsei Med J 2013;54:1370-6.
3 .Katsube T, Konnno S, Murayama M, et al. Changes of nutritional status after distal gastrectomy in patients with gastric cancer. Hepatogastroenterology2008;55:1864-7.
4 .Lim HS, Cho GS, Park YH, et al. Comparison of quality of life and nutritional status in gastric cancer patients undergoing gastrectomies. Clin Nutr Res2015;4:153-9.
5 .Bernini M, Bencini L, Sacchetti R, et al. The Cholegas Study:safety of prophylactic cholecystectomy during gastrectomy for cancer:preliminary results of a multicentric randomized clinical trial.Gastric Cancer 2013;16:370-6.
6 .Hirahara N, Tajima Y, Fujii Y, et al. Prognostic nutritional index as a predictor of survival in resectable gastric cancer patients with normal preoperative serum carcinoembryonic antigen levels:a propensity score matching analysis. BMC Cancer2018;18:285.
7 .Yang Y, Gao P, Song Y, et al. The prognostic nutritional index is a predictive indicator of prognosis and postoperative complications in gastric cancer:A meta-analysis. Eur J Surg Oncol 2016;42:1176-82.
8 .Sakurai K, Tamura T, Toyokawa T, et al. Low preoperative prognostic nutritional index predicts poor survival post-gastrectomy in elderly patients with gastric cancer. Ann Surg Oncol 2016;23:3669-76.
9 .Lee JY, Kim HI, Kim YN, et al. Clinical significance of the prognostic nutritional index for predicting short-and long-term surgical outcomes after gastrectomy:A retrospective analysis of 7781 gastric cancer patients. Medicine(Baltimore)2016;95:e3539.
10 .Oh SE, Choi MG, Seo JM, et al. Prognostic significance of perioperative nutritional parameters in patients with gastric cancer. Clin Nutr 2019;38:870-6.
11 .Fujiya K, Kawamura T, Omae K, et al. Impact of malnutrition after gastrectomy for gastric cancer on long-term survival. Ann Surg Oncol 2018;25:974-83.
12 .Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. Nihon Geka Gakkai Zasshi(in Japanese)1984;85:1001-5.
13 .Mohri Y, Inoue Y, Tanaka K, et al. Prognostic nutritional index predicts postoperative outcome in colorectal cancer. World J Surg 2013;37:2688-92.
14 .Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications:five-year experience. Ann Surg 2009;250:187-96.
15 .Murata A, Okamoto K, Muramatsu K, et al. Effects of additional laparoscopic cholecystectomy on outcomes of laparoscopic gastrectomy in patients with gastric cancer based on a national administrative database. J Surg Res 2014;186:157-63.
16 .Fukagawa T, Katai H, Saka M, et al. Gallstone formation after gastric cancer surgery. J Gastrointest Surg 2009;13:886-9.
17 .Kobayashi T, Hisanaga M, Kanehiro H, et al. Analysis of risk factors for the development of gallstones after gastrectomy. Br J Surg 2005;92:1399-403.
18 .Kwon AH, Inui H, Imamura A, et al. Laparoscopic cholecystectomy and choledocholithotomy in patients with a previous gastrectomy. J Am Coll Surg 2001;193:614-9.
19 .Karayiannakis AJ, Polychronidis A, Perente S, et al.Laparoscopic cholecystectomy in patients with previous upper or lower abdominal surgery. Surg Endosc 2004;18:97-101.
20 .Gillen S, Michalski CW, Schuster T, et al.Simultaneous/Incidental cholecystectomy during gastric/esophageal resection:systematic analysis of risks and benefits. World J Surg 2010;34:1008-14.
21 .Warschkow R, Tarantino I, Ukegjini K, et al.Concomitant cholecystectomy during laparoscopic Roux-en-Y gastric bypass in obese patients is not justified:a meta-analysis. Obes Surg 2013;23:397-407.
22 .Worni M, Guller U, Shah A, et al. Cholecystectomy concomitant with laparoscopic gastric bypass:a trend analysis of the nationwide inpatient sample from 2001to 2008. Obes Surg 2012;22:220-9.
2 .Shim H, Cheong JH, Lee KY, et al. Perioperative nutritional status changes in gastrointestinal cancer patients. Yonsei Med J 2013;54:1370-6.
3 .Katsube T, Konnno S, Murayama M, et al. Changes of nutritional status after distal gastrectomy in patients with gastric cancer. Hepatogastroenterology2008;55:1864-7.
4 .Lim HS, Cho GS, Park YH, et al. Comparison of quality of life and nutritional status in gastric cancer patients undergoing gastrectomies. Clin Nutr Res2015;4:153-9.
5 .Bernini M, Bencini L, Sacchetti R, et al. The Cholegas Study:safety of prophylactic cholecystectomy during gastrectomy for cancer:preliminary results of a multicentric randomized clinical trial.Gastric Cancer 2013;16:370-6.
6 .Hirahara N, Tajima Y, Fujii Y, et al. Prognostic nutritional index as a predictor of survival in resectable gastric cancer patients with normal preoperative serum carcinoembryonic antigen levels:a propensity score matching analysis. BMC Cancer2018;18:285.
7 .Yang Y, Gao P, Song Y, et al. The prognostic nutritional index is a predictive indicator of prognosis and postoperative complications in gastric cancer:A meta-analysis. Eur J Surg Oncol 2016;42:1176-82.
8 .Sakurai K, Tamura T, Toyokawa T, et al. Low preoperative prognostic nutritional index predicts poor survival post-gastrectomy in elderly patients with gastric cancer. Ann Surg Oncol 2016;23:3669-76.
9 .Lee JY, Kim HI, Kim YN, et al. Clinical significance of the prognostic nutritional index for predicting short-and long-term surgical outcomes after gastrectomy:A retrospective analysis of 7781 gastric cancer patients. Medicine(Baltimore)2016;95:e3539.
10 .Oh SE, Choi MG, Seo JM, et al. Prognostic significance of perioperative nutritional parameters in patients with gastric cancer. Clin Nutr 2019;38:870-6.
11 .Fujiya K, Kawamura T, Omae K, et al. Impact of malnutrition after gastrectomy for gastric cancer on long-term survival. Ann Surg Oncol 2018;25:974-83.
12 .Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. Nihon Geka Gakkai Zasshi(in Japanese)1984;85:1001-5.
13 .Mohri Y, Inoue Y, Tanaka K, et al. Prognostic nutritional index predicts postoperative outcome in colorectal cancer. World J Surg 2013;37:2688-92.
14 .Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications:five-year experience. Ann Surg 2009;250:187-96.
15 .Murata A, Okamoto K, Muramatsu K, et al. Effects of additional laparoscopic cholecystectomy on outcomes of laparoscopic gastrectomy in patients with gastric cancer based on a national administrative database. J Surg Res 2014;186:157-63.
16 .Fukagawa T, Katai H, Saka M, et al. Gallstone formation after gastric cancer surgery. J Gastrointest Surg 2009;13:886-9.
17 .Kobayashi T, Hisanaga M, Kanehiro H, et al. Analysis of risk factors for the development of gallstones after gastrectomy. Br J Surg 2005;92:1399-403.
18 .Kwon AH, Inui H, Imamura A, et al. Laparoscopic cholecystectomy and choledocholithotomy in patients with a previous gastrectomy. J Am Coll Surg 2001;193:614-9.
19 .Karayiannakis AJ, Polychronidis A, Perente S, et al.Laparoscopic cholecystectomy in patients with previous upper or lower abdominal surgery. Surg Endosc 2004;18:97-101.
20 .Gillen S, Michalski CW, Schuster T, et al.Simultaneous/Incidental cholecystectomy during gastric/esophageal resection:systematic analysis of risks and benefits. World J Surg 2010;34:1008-14.
21 .Warschkow R, Tarantino I, Ukegjini K, et al.Concomitant cholecystectomy during laparoscopic Roux-en-Y gastric bypass in obese patients is not justified:a meta-analysis. Obes Surg 2013;23:397-407.
22 .Worni M, Guller U, Shah A, et al. Cholecystectomy concomitant with laparoscopic gastric bypass:a trend analysis of the nationwide inpatient sample from 2001to 2008. Obes Surg 2012;22:220-9.