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Open Access

Use of non-operative treatment and interval cholecystectomy for cholecystitis in patients with cancer

David Santos, Celia Robinson Ledet, Angela Limmer, Heather Gibson, Brian Badgwell
DOI: 10.1136/tsaco-2020-000439 Published 6 May 2020
David Santos
Department of Surgical Oncology, UTMDACC, Houston, Texas, USA
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Celia Robinson Ledet
Department of Surgical Oncology, UTMDACC, Houston, Texas, USA
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Angela Limmer
Department of Surgical Oncology, UTMDACC, Houston, Texas, USA
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Heather Gibson
Department of Surgical Oncology, UTMDACC, Houston, Texas, USA
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Brian Badgwell
Department of Surgical Oncology, UTMDACC, Houston, Texas, USA
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  • Figure 1
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    Figure 1

    Description of study population by underlying cancer diagnosis. Cancers making up less than 2% of the population: CNS, endometrial, gastric, sarcoma, adenoid, bladder, duodenal, esophageal, GIST, intestinal carcinoid, laryngeal, nasopharyngeal, osteosarcoma, prostrate, vulvar, Waldenstrom's macroglobulinemia. CNS, central nervous system; GIST, gastrointestinal stromal tumor; MDS, myelodysplastic syndrome; NET, neuroendocrine tumor.

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    Figure 2

    Non-randomized assignment of patients to surgical and non-surgical treatments for acute cholecystitis. legend: ABX, antibiotics; Chole, cholecystectomy; IC, interval cholecystectomy; PCT, percutaneous cholecystostomy tube.

  • Figure 3
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    Figure 3

    Survival time after initial diagnosis of acute cholecystitis. Log rank p=0.02. ABX, antibiotics; PCT, percutaneous cholecystostomy tube.

Tables

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  • Table 1

    Univariate analysis of factors associated with resolution of acute cholecystitis with ABX versus PCTs

    ABXPCTP value
    Total N13254
    Age (years), median (IQR)57 (44–63)56 (44–66)0.95
    Sex (male)54 (41%)27 (28%)0.87
    Stem cell transplant26 (20%)8 (15%)0.30
    Hematologic malignancy52 (39%)28 (52%)0.50
    Abdominal malignancy36 (27%)17 (31%)1.00
    Chemo<6 wks59 (45%)31 (57%)0.61
    Abdominal radiation4 (3.0%)5 (9.3%)0.15
    Nausea/vmiting57 (43%)25 (46%)0.61
    Steroids18 (14%)7 (13%)0.65
    ANC (1000 cells/μL), median (IQR)3.5 (2.2–6.1)6.0 (1.6–6.2)0.004
    Platelets (1000/mL), median (IQR)125 (54–199)153 (63–246)0.29
    Length of stay (days), median (IQR)5 (2–10)8 (6–12)0.02
    ASA class
     I0 (0%)0 (0%)0.04
     II5 (3.8%)3 (5.6%)
     III92 (69.7%)27 (50%)
     IV34 (25.8%)24 (44%)
     V1 (0.8%)0 (0%)
    • Chemo<6 weeks indicates chemotherapy received less than 6 weeks to presentation.

    • ABX, antibiotics; ANC, absolute neutrophil count; ASA, American Society of Anesthesiologists; PCT, percutaneous cholecystostomy tube.

  • Table 2

    Multivariate analysis of factors associated with resolution versus non-resolution of acute cholecystitis

    ResolutionNo resolutionNP valueOR95% CI
    Total N15729186
    PCT51 (94%)3 (5.6%)540.034.891.18 to 20.2
    Age (years), median (IQR)57 (44–63)55 (43–65)1320.361.020.98 to 1.05
    Sex (male)54 (78%)15 (22%)690.260.570.21 to 1.52
    Abdominal malignancy36 (92%)3 (7.7%)390.026.661.36 to 32.6
    Abdominal radiation4 (57%)3 (34%)70.010.090.02 to 0.53
    Hematologic malignancy52 (74%)18 (26%)700.361.830.50 to 6.76
    Chemo<6 weeks59 (80%)15 (20%)740.680.810.30 to 2.18
    Stem cell transplant26 (20%)10 (7.6%)360.970.980.26 to 3.73
    ANC (1000 cells/μL), median (IQR)3.5 (2.2–6.1)2.6 (1.1–6.2)1250.870.980.90 to 1.06
    Steroids18 (82%)4 (18%)220.950.920.07 to 11.3
    Length of stay (days), median (IQR)7 (4–15)6 (3–10)1860.020.970.94 to 0.99
    ASA
    III
    99 (63%)20 (69%)1190.240.450.12 to 1.69
    • Chemo<6 weeks indicates chemotherapy received less than 6 weeks to presentation.

    • Area under the curve=0.78.

    • ANC, absolute neutrophil count; ASA, American Society of Anesthesiologists; PCT, percutaneous cholecystostomy tube.

  • Table 3

    Univariate analysis of factors associated IC versus no IC

    ICNo ICP value
    Total N6790
    Age (years), median (IQR)54 (50–57)55 (53–58)0.45
    Sex (male)48 (72%)33 (37%)0.63
    Stem cell transplant16 (24%)18 (20%)0.56
    Hematologic malignancy32 (48%)48 (53%)0.52
    Abdominal malignancy21 (31%)32 (36%)0.61
    Chemo<6 weeks33 (49%)57 (63%)0.10
    Abdominal radiation2 (3.0%)7 (7.8%)0.30
    Steroids8 (12%)17 (19%)0.28
    Nausea/vomiting41 (61%)41 (46%)0.06
    ANC (1000 cells/μL), median (IQR)6.4 (5.0–7.7)5.3 (3.8–6.9)0.36
    Platelets (1000/μL), median (IQR)171 (144–198)130 (108–152)0.02
    Length of stay (days), median (IQR)6 (3–9)6 (3–12)0.41
    ASA
     I0 (0%)0 (0%)0.58
     II7 (12%)7 (7.8%)
     III48 (80%)84 (93%)
     IV19 (32%)40 (44%)
     V0 (0%)1 (1.1%)
    • Chemo<6 weeks indicates chemotherapy received less than 6 weeks to presentation.

    • ANC, absolute neutrophil count; ASA, American Society of Anesthesiologists; IC, interval cholecystectomy; PCT, percutaneous cholecystostomy tube.

  • Table 4

    Multivariate analysis of factors associated with IC versus no IC

    ICNo ICNP valueOR95% CI
    Total N8294176
    Age (years), median (IQR)54 (50–57)55 (53–58)1760.831.000.97 to 1.02
    Sex (male)48 (72%)33 (37%)810.620.830.39 to 1.74
    Nausea, vomiting41 (61%)41 (46%)820.032.301.09 to 4.86
    Chemo<6 weeksxANC33 (49%)57 (63%)900.051.141.00 to 1.30
    Hematologic malignancy32 (48%)48 (53%)800.651.240.49 to 3.15
    Steroids8 (12%)17 (19%)250.130.440.15 to 1.27
    Platelets (1000/μL), median (IQR)171 (144–198)130 (108–152)1730.011.011.00 to 1.01
    Stem cell transplant16 (24%)18 (20%)340.491.460.49 to 4.32
    • Chemo<6 weeks indicates chemotherapy received less than 6 weeks to presentation.

    • Area under the curve=0.75.

    • ANC, absolute neutrophil count; IC, interval cholecystectomy; PCT, percutaneous cholecystostomy tube.

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Use of non-operative treatment and interval cholecystectomy for cholecystitis in patients with cancer
David Santos, Celia Robinson Ledet, Angela Limmer, Heather Gibson, Brian Badgwell
Trauma Surg Acute Care Open May 2020, 5 (1) e000439; DOI: 10.1136/tsaco-2020-000439

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Use of non-operative treatment and interval cholecystectomy for cholecystitis in patients with cancer
David Santos, Celia Robinson Ledet, Angela Limmer, Heather Gibson, Brian Badgwell
Trauma Surg Acute Care Open May 2020, 5 (1) e000439; DOI: 10.1136/tsaco-2020-000439
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Use of non-operative treatment and interval cholecystectomy for cholecystitis in patients with cancer
David Santos, Celia Robinson Ledet, Angela Limmer, Heather Gibson, Brian Badgwell
Trauma Surgery & Acute Care Open May 2020, 5 (1) e000439; DOI: 10.1136/tsaco-2020-000439
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