Acute cholecystitis (AC) in oncological patients; which treatment is adequate? The good, the bad, and the ugly

INTRODUCTION:

Acute cholecystitis is one of the most common diseases that the emergency surgeon may face, and immunosuppressed patients pose a therapeutic dilemma. Especially oncological patients, who usually combine the burden of active oncological treatment and the morbidities of their disease. In this context, evidence to decide the best way of action is necessary.

OBJECTIVE:

Our goal is to add evidence that oncological patients with acute cholecystitis should be treated surgically, to avoid additional morbi-mortality.

METHODS:

We reviewed 5 years of treated patients in our department; the criteria consisted of patients with acute cholecystitis who were under active oncological treatment (chemotherapy, radiotherapy, or immunotherapy).

RESULTS:

We include 43 patients (24 males (M) and 19 females (F) ), representing 7,4% of all AC patients treated in this period. The patients were treated following three different modalities; surgery, percutaneous drainage, or antibiotics:

- Surgery group: 14 patients (8 M 6 F), with a mean age of 70 years, a mean of 3 days of evolution, and a mean stay of 8 days. This group had a mortality of 1 patient (7,10%).

- Drainage group: 13 patients (7 M and 6 F), with a mean age of 76 years, a mean of 6 days of evolution, and a mean stay of 13 days. This group had a mortality of 3 patients (23,10%).

- ATB group: 16 patients (9M and 7 F) with a mean age of 67 years, mean of 4 days of evolution and mean of hospital stay of 11 days. This group had a mortality of 8 patients (50%).

CONCLUSIONS:

In our experience, we conclude that patients under oncological active treatment and AC should go under surgery if they are fit for it or if not at least receive a drainage treatment to do a proper septic control; so they can return to their oncological treatment sooner and in better condition.

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