{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T14:08:56Z","timestamp":1784297336378,"version":"3.55.0"},"reference-count":18,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T00:00:00Z","timestamp":1759795200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T00:00:00Z","timestamp":1759795200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Annals of Gastroent Surgery"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>With population aging and extended healthy life expectancy, the management of acute cholecystitis (AC) in patients aged \u2265\u200985\u2009years has evolved. However, the Tokyo Guidelines 2018 (TG18) for AC provide no specific risk assessment criteria for this population. This study aimed to evaluate the safety of applying the TG18 surgical algorithm to super\u2010elderly patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective study compared short\u2010 and long\u2010term outcomes between a super\u2010elderly group (\u2265\u200985\u2009years,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200960) and a younger group (70\u201384\u2009years,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009172) who underwent emergency surgery for AC.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In severity Grade I, no significant increase in overall (21.1% vs. 21.1%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20091.000) or major complications (5.3% vs. 5.6%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20091.000) was observed in the super\u2010elderly group. In Grade II, there was no significant increase in overall (28.6% vs. 30.1%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20091.000) or major complications (10.7% vs. 6.1%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.417). There was no mortality (0% vs. 2.3%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.575) in the super elderly group across the entire cohort. Multivariate analysis revealed that dementia was a relevant risk of overall complication (OR: 6.09,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.036), and Clavien\u2013Dindo grade was a relevant risk of nonhome discharge (OR: 2.38,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.012) in the super elderly group. No significant difference was observed in long\u2010term postoperative survival between the two groups (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.304).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In TG18 severity Grades I and II, decision\u2010making based on the TG18 algorithm can be safely applied to super\u2010elderly patients, allowing for surgical intervention with favorable postoperative outcomes. However, careful assessment is necessary to avoid underestimating perioperative risks.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ags3.70105","type":"journal-article","created":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T06:40:28Z","timestamp":1759905628000},"page":"570-577","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Validation of the Safe Application of Tokyo Guideline 2018 (\n                    <scp>TG18<\/scp>\n                    ) Severity Grading and Treatment Algorithm in Super\u2010Elderly Patients Aged 85 and Over With Acute Cholecystitis: A Study in the Japanese Tertiary Care Hospital"],"prefix":"10.1002","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6013-456X","authenticated-orcid":false,"given":"Yuta","family":"Kobayashi","sequence":"first","affiliation":[{"name":"Department of Gastroenterological Surgery Showa General Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryo","family":"Oikawa","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery Showa General Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yumi","family":"Shibuya","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery Showa General Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masakazu","family":"Tatsuno","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery Showa General Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atsuya","family":"Kamiyama","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery Showa General Hospital  Tokyo 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