Total gastrectomy, chemo linked to higher gallstone risk in gastric cancer survivors: study

The risk of gallstone disease requiring medical intervention after gastric cancer surgery differs significantly depending on the type of gastrectomy and individual patient factors, according to a recent study Severance Hospital and NHIS (National Health Insurance Service) Ilsan Hospital.

Professor Kim Hyung-il of the Yonsei Cancer Center led a nationwide NHIS-based study showing that 7.1 percent of gastric cancer survivors developed gallstone disease requiring treatment after gastrectomy. (Credit: Severance Hospital)

As more patients survive gastric cancer, the focus is expanding beyond immediate outcomes to the long-term complications that follow surgery.

Although gallstones are a well-known post-gastrectomy complication, the frequency with which they lead to invasive treatment has remained unclear.

The research team, led by Professors Kim Hyung-il of the Gastric Cancer Center at Yonsei Cancer Center and Choi Seo-hee of the Department of Surgery of the NHIS Ilsan Hospital, utilized data from the NHIS to analyze nearly 90,000 patients who underwent gastrectomy for gastric cancer between 2007 and 2020.

The study focused on the incidence and risk factors of symptomatic gallstone disease requiring medical intervention, rather than asymptomatic cases. The average follow-up period was 7.5 years, and patients with pre-existing gallbladder disease or liver dysfunction were excluded.

The analysis showed that 7.1 percent of the total patient group developed gallstone disease requiring treatment during the follow-up period. The cumulative incidence rate was 4.9 percent at five years and 8.9 percent at 10 years after surgery, indicating that the risk continues to increase as time passes.

Multivariate analysis revealed distinct risk factors. Patients who underwent total gastrectomy had a 1.8 times higher risk of developing gallstone disease compared to those who received partial gastrectomy. Additionally, patients who underwent adjuvant chemotherapy showed a 2.1 times higher risk.

Other factors significantly increasing the risk included old age, obesity, hypertension, diabetes, and a high number of comorbidities.

"The study is significant as it analyzed the long-term risk of gallstone disease leading to actual treatment rather than simple complications,” Professor Kim said. “We expect this to serve as important evidence for establishing long-term follow-up management strategies for gastric cancer surgery patients."

The study results were published in the International Journal of Surgery.