Reappraisal of Real-World Management of Acute Cholecystitis in Elderly Patients Based on the Adherence to Tokyo Guidelines 2018 (TG18): A Multicenter Study on Anzu HPB Surgical Meeting.

BACKGROUND

Although the Tokyo Guidelines 2018 (TG18) recommend optimal management for acute cholecystitis (AC) using an age-adjusted index, the implementation and outcomes of treatment strategies in elderly patients with AC remain unclear.

METHODS

A total of 461 patients aged ≥ 70 years with AC from five institutions were retrospectively analyzed, including those who underwent early surgery (n = 247) and later, elective surgery with (n = 114) or without (n = 100) preoperative gallbladder drainage. Patients were classified into three groups based on treatment strategy: A (consistent with TG18 recommendations, n = 206), B (more aggressive than TG18 recommendations, n = 135), and C (more conservative than TG18 recommendations, n = 120). Multivariate analyses were performed to identify potential surgical complication predictors.

RESULTS

Among Grade I/II AC patients, overall complication rates in Groups A, B, and C were 16.4%, 34.0%, and 8.3%, respectively (A vs. B: p < 0.001, A vs. C: p = 0.052) and major complication rates were 3.1%, 9.4%, and 5.0%, respectively (A vs. B: p = 0.029, A vs. C: p = 0.382). Laparoscopic approaches were most frequent in Group C (A, 59.7% vs. B, 22.6% vs. C, 96.6%, p < 0.001). Anticoagulant/antiplatelet therapy independently predicted major complications (odds ratio 3.10, p = 0.023).

CONCLUSION

In the present trial, treatment for AC was consistent with TG18 recommendations in 45% of patients. Compared with TG18-aligned treatment, more conservative treatment was associated with comparable morbidities, while more aggressive treatment was associated with a higher incidence of major morbidities.