Simultaneous cholecystectomy during esophagectomy: A systematic review and meta-analysis on gallstone formation and subsequent cholecystectomy rates.

[BACKGROUND] The necessity of performing simultaneous cholecystectomy (simCCE) during esophagectomy remains controversial, as postoperative biliary complications may occur due to vagal denervation and anatomical alterations. However, the incidence and need for subsequent cholecystectomy (subCCE) in these patients remain unclear. This meta-analysis aims to provide a pooled estimate of gallstone formation and subCCE rates following esophagectomy for cancer.

[METHODS] A systematic literature search was conducted following PRISMA guidelines using PubMed, Embase, Web of Science, and CENTRAL. Studies reporting the incidence of symptomatic gallstones and subCCE after esophagectomy for cancer were included. A meta-analysis of proportions was conducted to estimate the pooled incidence of gallstone formation and subCCE rates. Random-effects models were applied, with heterogeneity quantified using the I statistic and further explored through meta-regression. Results were visually presented using forest plots. Risk of bias was assessed using Joanna Briggs Institute Critical Appraisal Checklist.

[RESULTS] In five studies comprising 1557 patients the overall pooled subCCE proportion was estimated to be 2.0 % (95 % CI: 0.8 %-5.1 %). The pooled analysis of gallstone formation compromised four studies with 1493 patients and estimated a pooled gallstone formation rate of 9.3 % (95 % CI: 4.6 %-18.1 %). Among patients who developed gallstones (n = 109), 14.5 % (95 % CI: 4.0 %-41.0 %) required a subCCE.

[CONCLUSION] High heterogeneity was observed among studies reporting subCCE rates, and most lacked data on surgical access and procedure-related complications. A risk-adapted approach to simCCE should be considered, and future prospective studies are needed to refine patient selection, explore medical prophylaxis strategies and evaluate long-term and patient-reported outcomes.