Analysis of influence factors for gallstones after radical physiological anastomosis in gastric cancer
Objective To explore the incidence and influence factors of gallstones after radical physiologic anastomosis for gastric cancer.Methods The clinical data of patients with physiologic anastomosis in radical gastric cancer surgery from January 2014 to December 2020 were retrospectively analyzed,and patients divid-ed into a proximal gastrectomy(PG)group and distal gastrectomy(DG)group according to the extent of gas-trectomy;postoperative gallstone formation was taken as the endpoint event,and the cut-off date of follow-up was December 2022;Kaplan-Meier method was used to draw the cumulative event rate curve,and Log-Rank test used to compare the difference in the incidence of gallstones between the PG group and the DG group;propensity score matching was used to adjust the baseline information of the two groups and then robust esti-mation method Cox regression used to analyze the influencing factors for gallstone formation after radical physiological anastomosis for gastric cancer.Results A total of 355 patients were included in this study,with 92 in the DG group and 263 in the PG group;a total of 91 patients(25.63%)developed gallstones after surgery during the follow-up period;a total of 77 patients developed gallstones within two years after surgery,accounting for 84.61%of all gallstones;the incidence of gallstones in the PG group(25.48%)was higher than that in the DG group(10.87%)in the two years after surgery;propensity score matching constructed a bal-anced cohort of DG and PG groups and then evaluated 236 patients,84 cases in the DG and 152 cases in the PG groups.Cox regression analysis showed that proximal gastrectomy,hepatoduodenal ligament lymph node dissection and adjuvant chemotherapy were the independent risk factors for the occurrence of gallstones after surgery in patients with gastric cancer who had used physiologic anastomosis;Laparoscopic surgery was a protective factor for the occurrence of gallstones after surgery.Conclusion The incidence of gallstones after radical physiologic anastomosis for gastric cancer increased significantly within 2 years after surgery;patients with gastric cancer undergoing proximal gastrectomy,hepatoduodenal ligament lymph node dissection and adjuvant chemotherapy should be followed closely after surgery to avoid the development of symptomatic gallstones.
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