Management of acute cholecystitis in cancer patients: a comparative effectiveness approach
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- 作者：Thejus T. Jayakrishnan (1)
Ryan T. Groeschl (1)
Ben George (2)
James P. Thomas (2)
Sam Pappas (3)
T. Clark Gamblin (1)
Kiran K. Turaga (1) - 关键词：Cancer ; Cholecystitis ; Cholecystectomy ; Percutaneous cholecystostomy ; Decision analyses
- 刊名：Surgical Endoscopy
- 出版年：2014
- 出版时间：May 2014
- 年：2014
- 卷：28
- 期：5
- 页码：1505-1514
- 全文大小：413 KB
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Ryan T. Groeschl (1)
Ben George (2)
James P. Thomas (2)
Sam Pappas (3)
T. Clark Gamblin (1)
Kiran K. Turaga (1)
1. Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI, 53226, USA
2. Division of Medical Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
3. Division of Surgical Oncology, Department of Surgery, Loyola University Medical Center, Maywood, IL, USA - ISSN：1432-2218
文摘
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.