Background and Objectives: Early cholecystectomy (EC) is widely regarded as the first-line treatment for acute calculous cholecystitis (ACC). Current debate centers on the feasibility of EC as an option even for elderly patients. This study aims to determine whether age alone is an independent risk prediction factor for prognosis after EC for ACC. Materials and Methods: This study is a post-hoc analysis of the S.P.Ri.M.A.C.C. WSES prospective international multicenter observational study database, including patients with ACC undergoing EC. Univariate and multivariate analyses were conducted, examining different risk factors for major morbidity and mortality after EC. Results: In the univariate analyses, age was found to be a statistically significant risk factor for both 30-day major complications (p < 0.001) and 30-day mortality (p = 0.003). However, in the multivariate analysis, age alone was not a significant predictor for either outcome, with p-values of 0.419 and 0.094, respectively. The only significant risk factor associated with both 30-day mortality and major morbidity in the multivariate model was the POSSUM Physiological Score (PS). Conclusions: Age alone cannot be considered a reliable risk predictor for a complicated postoperative course after EC in patients with ACC. Frailty, rather than chronological age, should be assessed to predict the outcome of these patients.

Background: Malnutrition is associated with poorer clinical outcomes in esophagogastric cancers (EGCs). Enteral nutrition via feeding jejunostomy (FJ) is feasible and effective, although standardized criteria for its placement during staging laparoscopy (SL) are lacking. Here, we describe a case series with the aim of generate preliminary evidence in highlighting unmet needs in this setting. Methods: We retrospectively reviewed medical records of EGC patients who underwent FJ placement during SL at the Fondazione IRCCS Policlinico S. Matteo from January 2022 to December 2023. Patients with missing nutritional data or known metastatic disease were excluded. Results: We included 14 Caucasian patients aged 66 years (IQR: 56.3–69.5) with a median Body Mass Index (BMI) of 23.7 kg/m² (IQR: 21.6–26.3). The tumor location was the gastroesophageal junction in eight cases (57%), the body of the stomach in four cases (29%), and the esophagus in two cases (14%). At the time of diagnosis, all patients had experienced weight loss: 13.4% of body weight (IQR: 8.7–16.8) in the last 6 months; with high malnutrition risk scores: NRS-2002 = 3 (IQR: 2–4) and MUST = 2 (IQR: 1–2). Prior to FJ placement only four (29%) patients had tried oral nutrition supplements (ONS) and nine (64%) had been evaluated by dietitians. Home enteral nutrition (HEN) was started in twelve (86%) cases, with three (21%) providing total enteral nutrition and 9 (64%) as supplemental HEN, providing a median of 45.5% of energy needs (IQR: 32.6–68.2). Due to sufficient oral intake, HEN was not started in two cases (14%) and was discontinued in the first month in another two cases. In this series, FJ was in place but unused for a median duration of 11 days (IQR: 3–91). The median duration of HEN was 97 days (IQR: 40–135); with 5 (35%) patients achieving weight stability/gain. FJ-related complications requiring hospitalization occurred in three (21%) cases. Conclusions: In this case series, we observed a suboptimal utilization of the FJ. Several patients had not undergone ONS trials or dietitian assessment prior to FJ placement, while others retained the FJ for months without using it. Given the potential risks of FJ, standardized selection criteria are warranted; routine preoperative nutritional assessments before SL should be implemented to identify high-risk patients and optimize FJ placement.

Recent studies have shown that Procalcitonin (PCT) can predict severity, difficult laparoscopic cholecystectomy, open conversion, and post-operative morbidity after Early Cholecystectomy (EC) in patients with Acute Calculous Cholecystitis (ACC). However, these studies are limited by their small sample sizes and lack of statistical power. The present study is a post-hoc analysis of a large prospective study (the S.P.Ri.M.A.C.C. study) to evaluate the value of PCT, as a predictor for mortality after EC. The S.P.Ri.M.A.C.C. study is an observational multicentre prospective study endorsed by the World Society of Emergency Surgery (WSES). 1253 patients from 79 locations in 19 countries were enrolled between September 1, 2021, and September 1, 2022. In this post-hoc analyses, patients with incomplete information regarding PCT value were excluded. The Receiving Operating Characteristic (ROC) curve and Area Under the Curve (AUC) were used to study the diagnostic ability of PCT. Exact logistic regression model was used to define the Odds Ratio (OR). 612 patients were included in this post-hoc analysis. The AUC of the PCT value as a continuous variable in predicting 30-day mortality was 0.926 (95% CI 0.874-0.978). The best cut-off in predicting 30-day mortality was 4 ng/mL with a sensitivity of 90.9% (95% CI 58.7%-99.8%) and a specificity of 88% (95% CI 85.1%-90.5%). The negative predicting value for mortality was 99.8% (95%CI 98.9%-100%), while the positive predicting value was 12.2% (95%CI 6.01%- 21.3%). Patients with a PCT≥4 ng/mL had 72.19 (95%CI 10.01-3175.90) times higher odds to die after EC than patients with a PCT<4 ng/ml. The present study demonstrated the prognostic value of pre-operative PCT in predicting 30-day mortality after EC in patients with ACC.