ArticleWorld journal of surgery2026
Safety and Feasibility of Early Laparoscopic Cholecystectomy in High-Risk Acute Cholecystitis: A Critical Evaluation of Tokyo Guidelines 2018 Risk Stratification.
Article in World journal of surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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7 authors.
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Abstract
aimThis study evaluated the safety and appropriateness of early laparoscopic cholecystectomy (LapC) for acute cholecystitis classified as high-risk according to the Tokyo Guidelines 2018 (TG18).
methodsWe retrospectively analyzed 126 patients who underwent early LapC between January 2023 and August 2024. Patients were classified into high-risk (n = 67) and low-risk (n = 59) groups based on TG18 criteria. Primary endpoints were in-hospital mortality and major complications (Clavien-Dindo ≥ IIIa).
resultsNo in-hospital mortality occurred. Major complications were observed in seven patients (5.6%) with no significant difference between groups (6.0% vs. 5.1%, p = 0.467). Grade 3 cholecystitis was independently associated with overall complications (adjusted OR 3.12, 95% CI 1.03-21.47, p = 0.046). Among Grade 1-2 cases, neither age-adjusted Charlson Comorbidity Index (AA-CCI) nor American Society of Anesthesiologists Physical Status (ASA-PS) correlated with complications, whereas higher preoperative C-reactive protein was an independent predictor (adjusted OR 1.05, 95% CI 1.00-1.10, p = 0.037).
conclusionIn our single-center experience, early LapC was safely performed in TG18-defined high-risk patients with Grade 1-2 cholecystitis. Traditional static risk indicators (AA-CCI, ASA-PS) showed limited predictive value in our cohort, whereas dynamic inflammatory markers such as CRP showed potential for risk assessment, though further validation is needed.
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