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Percutaneous cholecystostomy in elderly patients with acute cholecystitis: a systematic review and meta-analysis

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Abstract

Percutaneous cholecystostomy (PC) is often preferred over early cholecystectomy (EC) for elderly patients presenting with acute cholecystitis (AC). However, there is a lack of solid data on this issue. Following the PRISMA guidelines, we searched the Medline and Web of Science databases for reports published before December 2022. Studies that assessed elderly patients (aged 65 years and older) with AC treated using PC, in comparison with those treated with EC, were included. Outcomes analyzed were perioperative outcomes and readmissions. The literature search yielded 3279 records, from which 7 papers (1208 patients) met the inclusion criteria. No clinical trials were identified. Patients undergoing PC comprised a higher percentage of cases with ASA III or IV status (OR 3.49, 95%CI 1.59–7.69, p = 0.009) and individuals with moderate to severe AC (OR 1.78, 95%CI 1.00–3.16, p = 0.05). No significant differences were observed in terms of mortality and morbidity. However, patients in the PC groups exhibited a higher rate of readmissions (OR 3.77, 95%CI 2.35–6.05, p < 0.001) and a greater incidence of persistent or recurrent gallstone disease (OR 12.60, 95%CI 3.09–51.38, p < 0.001). Elderly patients selected for PC, displayed greater frailty and more severe AC, but did not exhibit increased post-interventional morbidity and mortality compared to those undergoing EC. Despite their inferior life expectancy, they still presented a greater likelihood of persistent or recurrent disease compared to the control group.

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Data availability

The data that support this study are available from the corresponding author upon reasonable request.

References

  1. Lirussi F, Nassuato G, Passera D, Toso S, Zalunardo B, Monica F et al (1999) Gallstone disease in an elderly population: the Silea study. Eur J Gastroenterol Hepatol 11(5):485–491

    Article  CAS  PubMed  Google Scholar 

  2. Festi D, Dormi A, Capodicasa S, Staniscia T, Attili AF, Loria P et al (2008) Incidence of gallstone disease in Italy: results from a multicenter, population-based Italian study (the MICOL project). World J Gastroenterol 14(34):5282–5289

    Article  PubMed  PubMed Central  Google Scholar 

  3. Ambe PC, Weber SA, Christ H, Wassenberg D (2015) Primary cholecystectomy is feasible in elderly patients with acute cholecystitis. Aging Clin Exp Res 27(6):921–926

    Article  PubMed  Google Scholar 

  4. Cho JY, Han HS, Yoon YS, Ahn KS (2010) Risk factors for acute cholecystitis and a complicated clinical course in patients with symptomatic cholelithiasis. Arch Surg 145(4):329–333 (discussion 33)

    Article  PubMed  Google Scholar 

  5. Kolla SB, Aggarwal S, Kumar A, Kumar R, Chumber S, Parshad R et al (2004) Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a prospective randomized trial. Surg Endosc 18(9):1323–1327

    Article  CAS  PubMed  Google Scholar 

  6. Lo CM, Liu CL, Fan ST, Lai EC, Wong J (1998) Prospective randomized study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Ann Surg 227(4):461–467

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Macafee DA, Humes DJ, Bouliotis G, Beckingham IJ, Whynes DK, Lobo DN (2009) Prospective randomized trial using cost-utility analysis of early versus delayed laparoscopic cholecystectomy for acute gallbladder disease. Br J Surg 96(9):1031–1040

    Article  CAS  PubMed  Google Scholar 

  8. Yadav RP, Adhikary S, Agrawal CS, Bhattarai B, Gupta RK, Ghimire A (2009) A comparative study of early vs delayed laparoscopic cholecystectomy in acute cholecystitis. Kathmandu Univ Med J (KUMJ) 7(25):16–20

    CAS  PubMed  Google Scholar 

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

    Google Scholar 

  10. Okamoto K, Suzuki K, Takada T, Strasberg SM, Asbun HJ, Endo I, et al. Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis. Journal of Hepato-Biliary-Pancreatic Sciences. 2018;25(1):55–72 %*©2017 Japanese Society of Hepato-Biliary-Pancreatic Surgery %U https://onlinelibrary.wiley.com/doi/abs/https://doi.org/10.1002/jhbp.516.

  11. Pisano M, Allievi N, Gurusamy K, Borzellino G, Cimbanassi S, Boerna D et al (2020) 2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis. World J Emerg Surg WJES 15(1):61

    Article  PubMed  Google Scholar 

  12. Pisano M, Ceresoli M, Cimbanassi S, Gurusamy K, Coccolini F, Borzellino G et al (2019) 2017 WSES and SICG guidelines on acute calcolous cholecystitis in elderly population. World J Emerg Surg 14:10

    Article  PubMed  PubMed Central  Google Scholar 

  13. Lee SJ, Choi IS, Moon JI, Yoon DS, Lee SE, Sung NS et al (2021) Elective laparoscopic cholecystectomy is better than conservative treatment in elderly patients with acute cholecystitis after percutaneous transhepatic gallbladder drainage. J Gastrointest Surg 25(12):3170–3177

    Article  PubMed  Google Scholar 

  14. McGillicuddy EA, Schuster KM, Barre K, Suarez L, Hall MR, Kaml GJ et al (2012) Non-operative management of acute cholecystitis in the elderly. Br J Surg 99(9):1254–1261

    Article  CAS  PubMed  Google Scholar 

  15. Kirshtein B, Bayme M, Bolotin A, Mizrahi S, Lantsberg L (2008) Laparoscopic cholecystectomy for acute cholecystitis in the elderly: is it safe? Surg Laparosc Endosc Percutan Tech 18(4):334–339

    Article  PubMed  Google Scholar 

  16. Fuks D, Duhaut P, Mauvais F, Pocard M, Haccart V, Paquet JC et al (2015) A retrospective comparison of older and younger adults undergoing early laparoscopic cholecystectomy for mild to moderate calculous cholecystitis. J Am Geriatr Soc 63(5):1010–1016

    Article  PubMed  Google Scholar 

  17. Loozen CS, van Ramshorst B, van Santvoort HC, Boerma D (2018) Acute cholecystitis in elderly patients: a case for early cholecystectomy. J Visc Surg 155(2):99–103

    Article  CAS  PubMed  Google Scholar 

  18. Loozen CS, Van Ramshorst B, Van Santvoort HC, Boerma D (2017) Early cholecystectomy for acute cholecystitis in the elderly population: a systematic review and meta-analysis. Dig Surg 34(5):371–379

    Article  PubMed  Google Scholar 

  19. Di Martino M, Gancedo Quintana A, Vaello Jodra V, Sanjuanbenito Dehesa A, Morales Garcia D, Caina Ruiz R et al (2022) Early laparoscopic cholecystectomy in oldest-old patients: a propensity score matched analysis of a nationwide registry. Updates Surg 74(3):979–989

    Article  PubMed  Google Scholar 

  20. OCEBM Levels of Evidence Working Group*. “The Oxford 2011 Levels of Evidence”. 2020. https://www.cebm.net/wp-content/uploads/2014/06/CEBM-Levels-of-Evidence-2.1.pdf. Accessed 20 Feb 2021.

  21. Mora-Guzmán I, Di Martino M, Martín-Pérez E (2017) Recurrence of gallstone disease following non-surgical treatment of acute cholecystitis in the elderly population. Med Clin 148(12):570–571

    Article  Google Scholar 

  22. Mora-Guzmán I, Di Martino M, Bonito AC, Jodra VV, Hernández SG, Martin-Perez E (2020) Conservative management of gallstone disease in the elderly population: outcomes and recurrence. Scand J Surg 109(3):205–210

    Article  PubMed  Google Scholar 

  23. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339:b2700

    Article  PubMed  PubMed Central  Google Scholar 

  24. Lee SB, Oh JH, Park JH, Choi SP, Wee JH (2018) Differences in youngest-old, middle-old, and oldest-old patients who visit the emergency department. Clin Exp Emerg Med 5(4):249–255

    Article  PubMed  PubMed Central  Google Scholar 

  25. Di Martino M, Dorcaratto D, Primavesi F, Syn N, Blanco-Teres L, Dupre A et al (2022) Liver resection in elderly patients with extensive CRLM: are we offering an adequate treatment? A propensity score matched analysis. Eur J Surg Oncol 48(6):1331–1338

    Article  PubMed  Google Scholar 

  26. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383

    Article  CAS  PubMed  Google Scholar 

  27. Little JP (1995) Consistency of ASA grading. Anaesthesia 50(7):658–659

    CAS  PubMed  Google Scholar 

  28. Yokoe M, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Gomi H et al (2013) TG13 diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci 20(1):35–46

    Article  PubMed  Google Scholar 

  29. Cull JD, Velasco JM, Czubak A, Rice D, Brown EC (2014) Management of acute cholecystitis: prevalence of percutaneous cholecystostomy and delayed cholecystectomy in the elderly. J Gastrointest Surg 18(2):328–333

    Article  PubMed  Google Scholar 

  30. Garces-Albir M, Martin-Gorgojo V, Perdomo R, Molina-Rodriguez JL, Munoz-Forner E, Dorcaratto D et al (2020) Acute cholecystitis in elderly and high-risk surgical patients: is percutaneous cholecystostomy preferable to emergency cholecystectomy? J Gastrointest Surg 24(11):2579–2586

    Article  PubMed  Google Scholar 

  31. Hu YR, Pan JH, Tong XC, Li KQ, Chen SR, Huang Y (2015) Efficacy and safety of B-mode ultrasound-guided percutaneous transhepatic gallbladder drainage combined with laparoscopic cholecystectomy for acute cholecystitis in elderly and high-risk patients. BMC Gastroenterol 15:81

    Article  PubMed  PubMed Central  Google Scholar 

  32. Lin WC, Chang CW, Chu CH (2016) Percutaneous cholecystostomy for acute cholecystitis in high-risk elderly patients. Kaohsiung J Med Sci 32(10):518–525

    Article  PubMed  Google Scholar 

  33. Ni Q, Chen D, Xu R, Shang D (2015) The efficacy of percutaneous transhepatic gallbladder drainage on acute cholecystitis in high-risk elderly patients based on the Tokyo guidelines: a retrospective case-control study. Medicine (Baltimore) 94(34):e1442

    Article  PubMed  Google Scholar 

  34. Zeren S, Bayhan Z, Kocak C, Kesici U, Korkmaz M, Ekici MF et al (2017) Bridge treatment for early cholecystectomy in geriatric patients with acute cholecystitis: Percutaneous cholecystostomy. Ulus Travma Acil Cerrahi Derg 23(6):501–506

    PubMed  Google Scholar 

  35. Okamoto K, Suzuki K, Takada T, Strasberg SM, Asbun HJ, Endo I et al (2018) Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis. J Hepatobiliary Pancreat Sci 25(1):55–72

    Article  PubMed  Google Scholar 

  36. Abe K, Suzuki K, Yahagi M, Murata T, Sako H, Ishii Y (2019) The efficacy of PTGBD for acute cholecystitis based on the Tokyo guidelines 2018. World J Surg 43(11):2789–2796

    Article  PubMed  Google Scholar 

  37. Bundy J, Srinivasa RN, Gemmete JJ, Shields JJ, Chick JFB (2018) Percutaneous cholecystostomy: long-term outcomes in 324 patients. Cardiovasc Intervent Radiol 41(6):928–934

    Article  PubMed  Google Scholar 

  38. Di Martino M, Miguel Mesa D, Lopesino González JM, de la Hoz Rodríguez Á, Martín-Pérez E (2020) Safety of percutaneous cholecystostomy early removal: a retrospective cohort study. Surg Laparosc Endosc Percutaneous Tech 30(5):410–415

    Article  Google Scholar 

  39. Winbladh A, Gullstrand P, Svanvik J, Sandstrom P (2009) Systematic review of cholecystostomy as a treatment option in acute cholecystitis. HPB (Oxford) 11(3):183–193

    Article  PubMed  Google Scholar 

  40. McKay A, Abulfaraj M, Lipschitz J (2012) Short- and long-term outcomes following percutaneous cholecystostomy for acute cholecystitis in high-risk patients. Surg Endosc 26(5):1343–1351

    Article  PubMed  Google Scholar 

  41. Loozen CS, van Santvoort HC, van Duijvendijk P, Besselink MG, Gouma DJ, Nieuwenhuijzen GA et al (2018) Laparoscopic cholecystectomy versus percutaneous catheter drainage for acute cholecystitis in high risk patients (CHOCOLATE): multicentre randomised clinical trial. BMJ 363:k3965

    Article  PubMed  PubMed Central  Google Scholar 

  42. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

The authors declare they have no financial interests.

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Authors and Affiliations

  1. Division of Hepatobiliary and Liver Transplantation Surgery, A.O.R.N. Cardarelli, Naples, Italy

    Alfonso Terrone & Marcello Di Martino

  2. Department of Health Sciences, University of Piemonte Orientale, Novara, Italy

    Marcello Di Martino

  3. Department of Surgery, University Maggiore Hospital Della Carità, Novara, Italy

    Marcello Di Martino

  4. Department of General Surgery, Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

    Sara Saeidi

  5. Department of Surgery, Ospedale Santa Maria Della Stella, Orvieto, Italy

    Chiara Ranucci

  6. Department of Surgery, Madonna del Soccorso Hospital, San Benedetto del Tronto, Italy

    Salomone Di Saverio

  7. Department of Surgery, San Giuseppe Moscati Hospital, Aversa, Italy

    Antonio Giuliani

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  1. Alfonso Terrone
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Contributions

MDM and AG proposed the study; AT, MDM, SS and CR wrote the initial draft that was finally reviewed by listed co-authors. All listed co-authors were integrally involved in the formation of this manuscript via data acquisition and made significant contributions to the drafting and critical revisions of the manuscript. All authors gave final approval prior to submission for publication.

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Correspondence to Marcello Di Martino.

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Was waived because of the nature of the study (systematic review) and the utilisation of anonymous clinical data.

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Terrone, A., Di Martino, M., Saeidi, S. et al. Percutaneous cholecystostomy in elderly patients with acute cholecystitis: a systematic review and meta-analysis. Updates Surg 76, 363–373 (2024). https://doi.org/10.1007/s13304-023-01736-9

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  • DOI: https://doi.org/10.1007/s13304-023-01736-9

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