Faculty Collaboration Database

Management of acute cholecystitis in cancer patients: a comparative effectiveness approach. Surg Endosc 2014 May;28(5):1505-14

Date

04/02/2014

Pubmed ID

24687416

DOI

10.1007/s00464-013-3344-2

Scopus ID

2-s2.0-84900328041 (requires institutional sign-in at Scopus site)   7 Citations

Abstract

BACKGROUND: Host factors and therapy characteristics predispose cancer patients to a high risk of acute cholecystitis. Management of cholecystitis is often difficult given complex decision making involving the underlying cancer, possible interruption of treatment, and surgical fitness of the patient.

METHODS: A management pathway was developed for cholecystitis in cancer patients which incorporated patient-specific survival and risks of recurrence. Estimates were obtained from a multistage systematic review. A decision tree with a lifetime horizon was constructed to compare conventional strategies [conservative treatment (CT), percutaneous cholecystostomy (PC) and definitive cholecystectomy (DC)] with the new pathway (NP). The decision tree was optimized for highest estimated survival. Sensitivity analyses were performed.

RESULTS: In low surgical risk patients with cancer-specific survival of 12 months, the NP yielded estimated survivals of 11.9 versus 11.8 (CT) versus 11.8 (PC) versus 11.9 months for the DC arm. For high-risk patients, the estimated survival was 11.6 (NP), 9.9 (DC), 11.4 (PC), and 11 (CT) months, respectively. The decision to perform a DC at 6 weeks after a PC was optimum in patients expected to survive 24 months (23.2 months from the NP) or with a shorter expected survival but a high recurrence risk (>20 %). Model estimates were robust in sensitivity analyses.

CONCLUSIONS: Incorporation of the surgical risk and the risk of recurrent cholecystitis, while balancing the patient-specific survival and the impact of antineoplastic therapy in the management of cholecystitis yields improved survival. This work provides measures to evaluate surgical judgment, and can augment the physician-patient decision making.

Author List

Jayakrishnan TT, Groeschl RT, George B, Thomas JP, Pappas S, Gamblin TC, Turaga KK

Authors

Thomas Clark Gamblin MD Professor in the Surgery department at Medical College of Wisconsin
Ben George MD Professor in the Medicine department at Medical College of Wisconsin
James P. Thomas MD, PhD Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Cholecystectomy
Cholecystitis, Acute
Cholecystostomy
Disease Management
Humans
Neoplasms