Return to intended oncologic therapy after treatment for cholecystitis in cancer patients

Return to intended oncologic treatment is a patient-centric quality metric that has been associated with survival in multiple malignancies. Emergency general surgery conditions, such as cholecystitis, are frequent events that can disrupt treatment.

Our institutional database was queried using International Classification of Diseases, Ninth and Tenth Revision codes for patients on active cancer therapy who developed cholecystitis between January 1, 2010 and December 31, 2020. The primary outcome was return to intended oncologic treatment ≤6 weeks, stratified by whether patients were treated with surgery, drainage procedure, or no procedural management.

Of 129 patients, 52.7% (N = 68) returned to therapy within 6 weeks, whereas 22.5% (N = 29) had a >6-week delay and 24.8% (N = 32) never received additional cancer-directed therapy. Return to intended oncologic treatment ≤6 weeks was associated with lower Eastern Cooperative Oncology Group (ECOG) scores (ECOG 0-1 81.8% vs 52.5%, P = .023), and patients were more likely to have solid malignancies (57.4%) or multiple malignancy types (23.5%). Patients with hematologic malignancies (OR, 0.41; 95% confidence interval, 0.17-0.98; P = .044) and those who underwent drainage procedures (OR, 0.32; 95% confidence interval, 0.13-0.81; P = .016) were less likely to return to intended oncologic treatment ≤6 weeks. Only 3 patients who had a percutaneous cholecystotomy tube placed (8.9%) would later undergo cholecystectomy.

Half of the patients who develop cholecystitis while on cancer treatment return to intended oncologic treatment ≤6 weeks, and one-quarter will never return to treatment. Patients with hematologic malignancies and those who have drainage procedures are less likely to return to intended oncologic treatment ≤6 weeks. There is a low rate of interval cholecystectomy after percutaneous cholecystotomy tube placement, and percutaneous cholecystotomy tube is unlikely to expedite a return to cancer-directed therapy.