Journal of Minimally Invasive Surgery 2021; 24(3): 139-144  https://doi.org/10.7602/jmis.2021.24.3.139
Safe and feasible outcomes of cholecystectomy in extremely elderly patients (octogenarians vs. nonagenarians)
Su Min Kim, Min Ho Shin, Nam Kyu Choi
Division of Hepatobiliary-Pancreas and Liver Transplantation Surgery, Department of Surgery, Chosun University Hospital, Gwangju, Korea
Correspondence to: Nam Kyu Choi
Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju 61453, Korea
Tel: +82-62-220-3965
Fax: +82-62-228-3441
E-mail: cnk@chosun.ac.kr
ORCID:
https://orcid.org/0000-0003-0726-1353
Received: May 6, 2021; Revised: July 8, 2021; Accepted: July 15, 2021; Published online: September 15, 2021.
© The Korean Society of Endoscopic and Laparoscopic Surgeons.

cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Purpose: Cholecystectomy is the gold standard treatment for gallbladder disease. As life expectancy increases, awareness of cholecystitis treatment in the elderly changes. The safety and feasibility of cholecystectomy in octogenarians have been proven in many studies. Surgical treatment for cholecystitis should be considered in octogenarians and even nonagenarians. In this study, we aimed to assess the outcomes of cholecystectomy in octogenarians and nonagenarians with acute cholecystitis.
Methods: A total of 393 patients aged 80 to 89 years (352 octogenarians) and 90 to 99 years (41 nonagenarians) diagnosed with acute cholecystitis underwent cholecystectomy between March 2012 and June 2020. All patients were classified according to the Tokyo guidelines. The evaluated parameters included demographic data, surgical outcomes, American Society of Anesthesiologists physical status classification, and Tokyo guidelines.
Results: All 393 patients were analyzed and divided into two groups according to age; octogenarians (83.57 ± 2.64 years) and nonagenarians (92.98 ± 3.15 years). The survival rate was 97.7% for octogenarians and 97.6% for nonagenarians. Laparoscopic surgery was performed more in both groups (96.8% in octogenarians and 92.7% in nonagenarians) than open surgery (3.2% in octogenarians and 7.3% in nonagenarians). The operation time of the nonagenarian group (74.63 ± 30.83 minutes) was shorter than the octogenarian group (75.85 ± 34.63 minutes). The incidences of postoperative complications in the octogenarian and nonagenarian groups were as follows: pneumonia, 5.7% and 7.3%; bleeding, 1.7% and 2.4%; gastrointestinal symptoms, 6.0% and 2.4%; and bile leakage, 0.6% and 2.4%, respectively.
Conclusion: Cholecystectomy is a safe and efficient procedure for the treatment of acute cholecystitis in both octogenarians and nonagenarians.
Keywords: Cholecystitis, Aged, Laparoscopic cholecystectomy, Mortality


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