Ann Hepatobiliary Pancreat Surg.  2018 Nov;22(4):374-379. 10.14701/ahbps.2018.22.4.374.

Clinical outcomes of laparoscopic cholecystectomy in elderly patients after preoperative assessment and optimization of comorbidities

• Shin MS
• Park SH

• KMID: 2427369
• DOI: http://doi.org/10.14701/ahbps.2018.22.4.374

Abstract

BACKGROUNDS/AIMS
Early laparoscopic cholecystectomy is considered as the standard treatment of acute cholecystitis. However, whether this procedure is desirable in elderly patients with acute cholecystitis is not clearly elucidated. In this study, we aimed to evaluate the effects of thorough preoperative assessment and consultation for complications on clinical outcomes in elderly patients over 65 and over 80 years.
METHODS
We retrospectively analyzed 205 patients who were diagnosed with acute cholecystitis between January 2010 and April 2018. The patients were assigned to three groups: group A (aged < 65 years), group B, (aged between 65 and 79 years), and group C (aged >79 years). Laparoscopic cholecystectomy was performed after preoperative evaluation, such as echocardiography, pulmonary function test, and consultation about past history.
RESULTS
Significant differences were not found in the complication rate among the age groups. Open conversion was required in eight of the 114 patients in group A, seven of the 70 patients in group B, and one of the 21 patients in group C. However, no statistical significance was found. Moreover, no difference was noted in the start of the meal and the period from surgery to last visit, but hospital stay after surgery was longer in groups b and c.
CONCLUSIONS
When sufficient preoperative assessment and treatment were performed, complication and conversion rates were not significantly different among the age groups. In extremely elderly patients, preoperative evaluation and elective laparoscopic cholecystectomy were desirable.

Keyword

Cholecystitis; Old age; Preoperative assessment

MeSH Terms

Aged*
Cholecystectomy, Laparoscopic*
Cholecystitis
Cholecystitis, Acute
Comorbidity*
Echocardiography
Humans
Length of Stay
Meals
Respiratory Function Tests
Retrospective Studies

Reference

1. Festi D, Dormi A, Capodicasa S, Staniscia T, Attili AF, Loria P, et al. Incidence of gallstone disease in Italy: results from a multicenter, population-based Italian study (the MICOL project). World J Gastroenterol. 2008; 14:5282–5289. PMID: 18785280.

2. Lirussi F, Nassuato G, Passera D, Toso S, Zalunardo B, Monica F, et al. Gallstone disease in an elderly population: the Silea study. Eur J Gastroenterol Hepatol. 1999; 11:485–491. PMID: 10755250.

3. Papi C, Catarci M, D'Ambrosio L, Gili L, Koch M, Grassi GB, et al. Timing of cholecystectomy for acute calculous cholecystitis: a meta-analysis. Am J Gastroenterol. 2004; 99:147–155. PMID: 14687156.

4. Gurusamy KS, Davidson C, Gluud C, Davidson BR. Early versus delayed laparoscopic cholecystectomy for people with acute cholecystitis. Cochrane Database Syst Rev. 2013; (6):CD005440. PMID: 23813477.

5. Gurusamy K, Samraj K, Gluud C, Wilson E, Davidson BR. Meta-analysis of randomized controlled trials on the safety and effectiveness of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg. 2010; 97:141–150. PMID: 20035546.

6. Gutt CN, Encke J, Köninger J, Harnoss JC, Weigand K, Kipfmüller K, et al. Acute cholecystitis: early versus delayed cholecystectomy, a multicenter randomized trial (ACDC study, NCT00447304). Ann Surg. 2013; 258:385–393. PMID: 24022431.

7. Kolla SB, Aggarwal S, Kumar A, Kumar R, Chumber S, Parshad R, et al. Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a prospective randomized trial. Surg Endosc. 2004; 18:1323–1327. PMID: 15803229.

8. Banz V, Gsponer T, Candinas D, Güller U. Population-based analysis of 4113 patients with acute cholecystitis: defining the optimal time-point for laparoscopic cholecystectomy. Ann Surg. 2011; 254:964–970. PMID: 21817893.

9. Pearse RM, Moreno RP, Bauer P, Pelosi P, Metnitz P, Spies C, et al. Mortality after surgery in Europe: a 7 day cohort study. Lancet. 2012; 380:1059–1065. PMID: 22998715.

10. Pessaux P, Tuech JJ, Derouet N, Rouge C, Regenet N, Arnaud JP. Laparoscopic cholecystectomy in the elderly: a prospective study. Surg Endosc. 2000; 14:1067–1069. PMID: 11116421.

11. Ambe PC, Weber SA, Christ H, Wassenberg D. Primary cholecystectomy is feasible in elderly patients with acute cholecystitis. Aging Clin Exp Res. 2015; 27:921–926. PMID: 25905472.

12. Fuks D, Duhaut P, Mauvais F, Pocard M, Haccart V, Paquet JC, et al. A retrospective comparison of older and younger adults undergoing early laparoscopic cholecystectomy for mild to moderate calculous cholecystitis. J Am Geriatr Soc. 2015; 63:1010–1016. PMID: 25946647.

13. Fukami Y, Kurumiya Y, Mizuno K, Sekoguchi E, Kobayashi S. Cholecystectomy in octogenarians: be careful. Updates Surg. 2014; 66:265–268. PMID: 25266894.

14. Loozen CS, van Ramshorst B, van Santvoort HC, Boerma D. Early cholecystectomy for acute cholecystitis in the elderly population: a systematic review and meta-analysis. Dig Surg. 2017; 34:371–379. PMID: 28095385.

15. Yetkin G, Uludag M, Oba S, Citgez B, Paksoy I. Laparoscopic cholecystectomy in elderly patients. JSLS. 2009; 13:587–591. PMID: 20202402.

16. Lee SI, Na BG, Yoo YS, Mun SP, Choi NK. Clinical outcome for laparoscopic cholecystectomy in extremely elderly patients. Ann Surg Treat Res. 2015; 88:145–151. PMID: 25741494.

17. Tokyo Guidelines for the management of acute cholangitis and cholecystitis. Proceedings of a consensus meeting, April 2006, Tokyo, Japan. J Hepatobiliary Pancreat Surg. 2007; 14:1–121.

18. Yokoe M, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Gomi H, et al. New diagnostic criteria and severity assessment of acute cholecystitis in revised Tokyo Guidelines. J Hepatobiliary Pancreat Sci. 2012; 19:578–585. PMID: 22872303.

19. Kuy S, Sosa JA, Roman SA, Desai R, Rosenthal RA. Age matters: a study of clinical and economic outcomes following cholecystectomy in elderly Americans. Am J Surg. 2011; 201:789–796. PMID: 21741511.

20. Riall TS, Zhang D, Townsend CM Jr, Kuo YF, Goodwin JS. Failure to perform cholecystectomy for acute cholecystitis in elderly patients is associated with increased morbidity, mortality, and cost. J Am Coll Surg. 2010; 210:668–677. PMID: 20421027.

21. Kim KH, Sung CK, Park BK, Kim WK, Oh CW, Kim KS. Percutaneous gallbladder drainage for delayed laparoscopic cholecystectomy in patients with acute cholecystitis. Am J Surg. 2000; 179:111–113. PMID: 10773145.

22. Winbladh A, Gullstrand P, Svanvik J, Sandström P. Systematic review of cholecystostomy as a treatment option in acute cholecystitis. HPB (Oxford). 2009; 11:183–193. PMID: 19590646.

23. Ha JP, Tsui KK, Tang CN, Siu WT, Fung KH, Li MK. Cholecystectomy or not after percutaneous cholecystostomy for acute calculous cholecystitis in high-risk patients. Hepatogastroenterology. 2008; 55:1497–1502. PMID: 19102330.

24. Cull JD, Velasco JM, Czubak A, Rice D, Brown EC. Management of acute cholecystitis: prevalence of percutaneous cholecystostomy and delayed cholecystectomy in the elderly. J Gastrointest Surg. 2014; 18:328–333. PMID: 24197550.

25. Kim IG, Kim JS, Jeon JY, Jung JP, Chon SE, Kim HJ, et al. Percutaneous transhepatic gallbladder drainage changes emergency laparoscopic cholecystectomy to an elective operation in patients with acute cholecystitis. J Laparoendosc Adv Surg Tech A. 2011; 21:941–946. PMID: 22129145.

26. Sutcliffe RP, Hollyman M, Hodson J, Bonney G, Vohra RS, Griffiths EA. Preoperative risk factors for conversion from laparoscopic to open cholecystectomy: a validated risk score derived from a prospective U.K. database of 8820 patients. HPB (Oxford). 2016; 18:922–928. PMID: 27591176.

27. Na BG, Yoo YS, Mun SP, Kim SH, Lee HY, Choi NK. The safety and efficacy of percutaneous transhepatic gallbladder drainage in elderly patients with acute cholecystitis before laparoscopic cholecystectomy. Ann Surg Treat Res. 2015; 89:68–73. PMID: 26236695.

28. Merriam LT, Kanaan SA, Dawes LG, Angelos P, Prystowsky JB, Rege RV, et al. Gangrenous cholecystitis: analysis of risk factors and experience with laparoscopic cholecystectomy. Surgery. 1999; 126:680–685. PMID: 10520915.

29. McGillicuddy EA, Schuster KM, Barre K, Suarez L, Hall MR, Kaml GJ, et al. Non-operative management of acute cholecystitis in the elderly. Br J Surg. 2012; 99:1254–1261. PMID: 22829411.

30. Wiggins T, Markar SR, Mackenzie H, Jamel S, Askari A, Faiz O, et al. Evolution in the management of acute cholecystitis in the elderly: population-based cohort study. Surg Endosc. 2018; 32:4078–4086. PMID: 30046948.

31. Nikfarjam M, Yeo D, Perini M, Fink MA, Muralidharan V, Starkey G, et al. Outcomes of cholecystectomy for treatment of acute cholecystitis in octogenarians. ANZ J Surg. 2014; 84:943–948. PMID: 23910372.