Abstract
Introduction: Background & Aim: AC affects over 20 million Americans and leads to an annual cost exceeding US$ 6 billion. Optimal treatment is early cholecystectomy. Patients with PBCA and AC may be very challenging to manage and often require multiple procedure interventions. We aim to study our long-term institutional experience of patients with PBCA undergoing PCT. Methods: Methods: Retrospective cohort study of high-risk surgical patients with AC hospitalized at the Cleveland Clinic between 2002 and 2017. AC, PBCA and PCT were identified by ICD9 codes. The primary outcome was inpatient mortality, PCT complications and re-interventions. We adjusted for age, gender and BMI. We constructed multivariable logistic regression models using SAS software. Results: Results: PCT was placed in 377 patients, 25 (6.7%) of these patients had a PBCA causing AC. Most common malignancy was pancreatic cancer, 13 (52%), followed by liver metastases, 7 (28%), ampullary masses, 3 (12%), and cholangiocarcinoma, 2 (8%). Patients with PBCA were more likely to have interventions done than patients without malignancy, as 12% vs 2% had PTHC placement (p=0.003) and 16% vs 5% had ERCP post PCT placement (p=0.039). Interestingly, patients with malignancy required less ICU admissions than patients without, 24% vs 59% (p<0.001), with less subsequent inhospital deaths, 12% vs 21%, although not statistically different (p=0.30). Conclusion: Limitations: Retrospective study, potential misclassification (some PTC patients will not have ICD9 code). Strength: Robust patient cohort. Long-term follow up. Adjusted for age, gender and race. Limited data on PBCA and PCT outcomes. Conclusion: PCT is a viable option for PBCA patients with AC not suitable for emergent cholecystectomy, However it is associated with high rate of other interventions (PTHC, ERCP). PBCA had lower mortality and ICU requirement, which is surprising. Further and larger studies are needed to further study this topic.35_A Figure 1. Outcomes of interest and cancer
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