{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,12]],"date-time":"2026-07-12T07:07:28Z","timestamp":1783840048485,"version":"3.55.0"},"reference-count":17,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2026,7]]},"abstract":"ABSTRACT<\/jats:title>\n \n Aim<\/jats:title>\n This study evaluated the safety and appropriateness of early laparoscopic cholecystectomy (LapC) for acute cholecystitis classified as high\u2010risk according to the Tokyo Guidelines 2018 (TG18).<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n We retrospectively analyzed 126 patients who underwent early LapC between January 2023 and August 2024. Patients were classified into high\u2010risk (\n n<\/jats:italic>\n \u00a0=\u00a067) and low\u2010risk (\n n<\/jats:italic>\n \u00a0=\u00a059) groups based on TG18 criteria. Primary endpoints were in\u2010hospital mortality and major complications (Clavien\u2010Dindo\u00a0\u2265\u00a0IIIa).\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n No in\u2010hospital mortality occurred. Major complications were observed in seven patients (5.6%) with no significant difference between groups (6.0% vs. 5.1%,\n p<\/jats:italic>\n \u00a0=\u00a00.467). Grade 3 cholecystitis was independently associated with overall complications (adjusted OR 3.12, 95% CI 1.03\u201321.47,\n p<\/jats:italic>\n \u00a0=\u00a00.046). Among Grade 1\u20132 cases, neither age\u2010adjusted Charlson Comorbidity Index (AA\u2010CCI) nor American Society of Anesthesiologists Physical Status (ASA\u2010PS) correlated with complications, whereas higher preoperative C\u2010reactive protein was an independent predictor (adjusted OR 1.05, 95% CI 1.00\u20131.10,\n p<\/jats:italic>\n \u00a0=\u00a00.037).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n In our single\u2010center experience, early LapC was safely performed in TG18\u2010defined high\u2010risk patients with Grade 1\u20132 cholecystitis. Traditional static risk indicators (AA\u2010CCI, ASA\u2010PS) showed limited predictive value in our cohort, whereas dynamic inflammatory markers such as CRP showed potential for risk assessment, though further validation is needed.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/wjs.70416","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T13:30:53Z","timestamp":1778506253000},"page":"1894-1902","source":"Crossref","is-referenced-by-count":0,"title":["Safety and Feasibility of Early Laparoscopic Cholecystectomy in High\u2010Risk Acute Cholecystitis: A Critical Evaluation of Tokyo Guidelines 2018 Risk Stratification"],"prefix":"10.1002","volume":"50","author":[{"given":"Yuya","family":"Miyoshi","sequence":"first","affiliation":[{"name":"Department of Surgery Okayama City Hospital Okayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8643-5037","authenticated-orcid":false,"given":"Shinsuke","family":"Hashida","sequence":"additional","affiliation":[{"name":"Department of Surgery Okayama City Hospital Okayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masayoshi","family":"Ohki","sequence":"additional","affiliation":[{"name":"Department of Surgery Okayama City Hospital Okayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sumiharu","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Department of Surgery Okayama City Hospital Okayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hirokuni","family":"Ikeda","sequence":"additional","affiliation":[{"name":"Department of Surgery Okayama City Hospital Okayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobuyasu","family":"Hayashi","sequence":"additional","affiliation":[{"name":"Department of Surgery Okayama City Hospital Okayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazunori","family":"Tsukuda","sequence":"additional","affiliation":[{"name":"Department of Surgery Okayama City Hospital Okayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,11]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/jhbp.515"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/jhbp.516"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/0021\u20109681(87)90171\u20108"},{"key":"e_1_2_12_5_1","first-page":"111","article-title":"New Classification of Physical Status","volume":"24","author":"Dripps R. D.","year":"1963","journal-title":"Anesthesiology"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12893\u2010025\u201002124\u20108"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2025.0667"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12154903"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.asjsur.2022.07.004"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/jhbp.456"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/ggi.14651"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.2012.64"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2011.07.018"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.10280"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13017\u2010015\u20100052\u20105"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464\u2010010\u20101430\u20106"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1089\/lap.2017.0144"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.7602\/jmis.2022.25.4.139"}],"container-title":["World Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/wjs.70416","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/wjs.70416","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/wjs.70416","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,12]],"date-time":"2026-07-12T06:09:57Z","timestamp":1783836597000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/wjs.70416"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,11]]},"references-count":17,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1002\/wjs.70416"],"URL":"https:\/\/doi.org\/10.1002\/wjs.70416","archive":["Portico"],"relation":{},"ISSN":["0364-2313","1432-2323"],"issn-type":[{"value":"0364-2313","type":"print"},{"value":"1432-2323","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,11]]}}}