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January 22, 2026Open Access

Incidence and risk factors for symptomatic gallstone disease after gastrectomy for gastric cancer: a nationwide population-based study

Puntos clave

This study aims to determine the incidence and risk factors for symptomatic gallstone disease after gastrectomy for gastric cancer.
Nationwide cohort study using claims data from the Korean National Health Insurance Service Database.
Included 90,456 patients who underwent gastrectomy for gastric cancer from 2007 to 2020.
Primary outcome measured was symptomatic gallstone disease requiring invasive intervention (e.g., cholecystectomy).
Cox proportional hazards analysis was used to estimate hazard ratios and confidence intervals.
7.1% of patients developed symptomatic gallstone disease requiring invasive intervention over a mean follow-up of 7.5 years.
Five-year and ten-year cumulative incidences were 4.9% and 8.9%, respectively.
Independent risk factors included age, body mass index ≥ 25 kg/m², hypertension, diabetes mellitus, and total gastrectomy.
Protective factors included female sex, pylorus-preserving gastrectomy, and laparoscopic surgery.

Resumen

Background: Gallstone formation is a potential long-term complication of gastrectomies. However, data on symptomatic gallstone disease after gastrectomy for gastric cancer are limited. This nationwide population-based study aimed to determine the incidence and risk factors of symptomatic gallstone disease requiring invasive intervention. Method: This nationwide cohort study was based on claims data from the Korean National Health Insurance Service Database. The study included 90 456 patients who underwent gastrectomy for gastric cancer between 2007 and 2020 after excluding individuals with prior gallbladder disease, liver dysfunction, or ursodeoxycholic acid use. The primary outcome was symptomatic gallstone disease that required invasive intervention (cholecystectomy or endoscopic/percutaneous biliary procedures). Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using the Cox proportional hazards analysis. Results: During a mean follow-up of 7.5 years, 6465 patients (7.1%) developed symptomatic gallstone disease requiring invasive intervention, with 5-year and 10-year cumulative incidences of 4.9% and 8.9%, respectively. Independent risk factors included age 60–79 years (HR 1.49, 95% CI 1.25–1.78) and ≥ 80 years (HR 2.10, 95% CI 1.69–2.61), body mass index ≥ 25 kg/m 2 (HR 1.25, 95% CI 1.19–1.32), hypertension (HR 1.10, 95% CI 1.04–1.16), diabetes mellitus (HR 1.10, 95% CI 1.04–1.17), Charlson Comorbidity Index ≥ 6 (HR 1.32, 95% CI 1.23–1.43), total gastrectomy (HR 1.80, 95% CI 1.70–1.90), and adjuvant chemotherapy (HR 2.11, 95% CI 1.98–2.24). Female sex (HR 0.76, 95% CI 0.71–0.82), pylorus-preserving gastrectomy (HR 0.47, 95% CI 0.33–0.67), and laparoscopic surgery (HR 0.85, 95% CI 0.81–0.90) were protective. Conclusion: 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. Pylorus-preserving gastrectomy and laparoscopic surgery were associated with a lower risk, suggesting that the surgical approach may influence the long-term gallstone risk.

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