Gastrectomy Increases Risk of Gallstone Disease in Gastric Cancers

Symptomatic gallstone disease requiring invasive intervention affected 7.1% of patients following gastrectomy for gastric cancer, according to findings from a nationwide population-based study published in the International Journal of Surgery.¹ Using data from the Korean National Health Insurance Service (NHIS), the investigators identified a substantial increase in gallstone risk compared with the general population.

In a press release on the findings, Professor Kim Hyung-il, of the gastric center at Yonsei Cancer Center, said, “The study is significant as it analyzed the long-term risk of gallstone disease leading to actual treatment rather than simple complications. We expect this to serve as important evidence for establishing long-term follow-up management strategies for [patients undergoing] gastric cancer surgery.”²

Clinical Outcomes and Risk Analysis

The clinical analysis revealed that the cumulative incidence of symptomatic gallstone disease rose gradually over time, reaching 4.9% at 5 years and 8.9% at 10 years post-gastrectomy. In a multivariable analysis, several factors were identified as independent drivers of increased risk. Patients aged 80 years or older faced more than double the risk (HR, 2.10; 95% CI, 1.69-2.61) compared with those in the 19 to 39 years age group. Additionally, a body mass index of 25 kg/m² or higher (HR, 1.25; 95% CI, 1.19-1.32), hypertension (HR, 1.10; 95% CI, 1.04-1.16), and diabetes mellitus (HR, 1.10; 95% CI, 1.04-1.17) significantly contributed to the likelihood of developing symptomatic disease. The severity of comorbidities also played a role, with a Charlson Comorbidity Index of 6 or greater associated with an increased hazard (HR, 1.32; 95% CI, 1.23-1.43).

The analysis identified specific surgical factors that may mitigate long-term gallstone risk. Pylorus-preserving gastrectomy was associated with a significantly lower risk of symptomatic disease requiring invasive intervention (HR, 0.47; 95% CI, 0.33-0.67; P <.001) compared with distal gastrectomy. Conversely, total gastrectomy was associated with a higher risk (HR, 1.80; 95% CI, 1.70-1.90; P <.001). Laparoscopic surgery also demonstrated a protective effect relative to open surgery (HR, 0.85; 95% CI, 0.81-0.90; P <.001).

The administration of adjuvant chemotherapy (HR, 2.11; 95% CI, 1.98-2.24; P <.001) was associated with a markedly higher risk of symptomatic gallstone disease vs no adjuvant chemotherapy.

These findings suggest that a surgical approach and perioperative management significantly influence long-term outcomes, leading the authors to recommend individualized preventive strategies for high-risk patients. “Symptomatic gallstone disease requiring invasive intervention occurred in 7.1% of the patients after gastrectomy for gastric cancer, representing a substantial increase compared to the general population,” the study authors stated.

They further explained that managing these cases is particularly challenging because “surgical management can be technically demanding because postoperative adhesions increase the risk of bile duct injury, conversion to open surgery, and prolonged operative time”. Furthermore, endoscopic options are often limited by the altered gastrointestinal anatomy resulting from the primary cancer surgery.

Study Breakdown

The study was a retrospective cohort analysis encompassing 90,456 adult patients who underwent curative gastrectomy for primary gastric cancer between 2007 and 2020. Eligibility required participants to have available data from the National Health Screening Program within 2 years prior to surgery and be at least 19 years of age. Exclusion criteria ruled out patients with pre-existing gallbladder, biliary, or pancreatic diagnoses, liver dysfunction, or prior use of ursodeoxycholic acid, among other criteria.

The surgical interventions evaluated included distal, total, proximal, and pylorus-preserving gastrectomies performed through either open or laparoscopic approaches. Adjuvant chemotherapy was also tracked as a significant variable, identified through anticancer drug codes. The primary end point was defined as the development of symptomatic gallstone disease requiring invasive interventions, such as cholecystectomy or endoscopic retrograde cholangiopancreatography.

References

1. Choi S, Youk T, Hwang J, et al. Incidence and risk factors for symptomatic gallstone disease after gastrectomy for gastric cancer: a nationwide population-based study. Int J Surg. 2026;00:1-8. doi:10.1097/JS9.0000000000004771
2. Total gastrectomy, chemo linked to higher gallstone risk in gastric cancer survivors: study. News release. Korea Biomedical Review. February 13, 2026. Accessed February 17, 2026. https://tinyurl.com/3bnwxn3f