N. R. Jariwalla1, M. Aburajab2, A. H. Khan2, K. Dua2, M. Aldakkak1, K. K. Christians1, B. George3, P. S. Ritch3, B. A. Erickson4, W. A. Hall4, M. Griffin5, D. B. Evans1, S. Tsai1 1Medical College Of Wisconsin,Surgical Oncology/Surgery,Milwaukee, WI, USA 2Medical College Of Wisconsin,Gastroenterology/Medicine,Milwaukee, WI, USA 3Medical College Of Wisconsin,Hematology Oncology/Medicine,Milwaukee, WI, USA 4Medical College Of Wisconsin,Radiation Oncology,Milwaukee, WI, USA 5Medical College Of Wisconsin,Radiology,Milwaukee, WI, USA
Introduction:
Patients with localized pancreatic cancer (PC) often have a biliary stent placed to relieve obstructive jaundice. During neoadjuvant therapy, they are at risk of developing acute cholecystitis. The potential for treatment of cholecystitis to cause a delay in pancreatic cancer therapy is not well understood.
Methods:
Treatment details were abstracted on consecutive patients with localized PC who had a biliary stent placed at the time of diagnosis. Stent-related complications were noted and the time from stent placement to the development of a stent-related complication during the neoadjuvant treatment period was calculated. Patients were categorized as having surgical versus non-surgical management of the cholecystitis. Time to surgery was defined as the time from the start of treatment to surgery.
Results:
Data was available for 283 patients, 121 (43%) with resectable and 162 (57%) with borderline resectable PC. Of the 283 patients, acute cholecystitis occurred in 17 (6%) patients. There was no association between the development of cholecystitis with clinical disease stage (p = 0.80) or type of neoadjuvant therapy (p =0.50). The median time to cholecystitis from date of stent placement was 2.3 months; 2 patients developed cholecystitis within the first week while the remaining 15 patients developed cholecystitis at a median of 2.6 months from stent placement. Acute cholecystitis was managed with cholecystostomy tube placement in 15 (88%) patients and cholecystectomy in 2 (12%). In total, 189 (67%) of the 283 patients completed all intended neoadjuvant therapy and surgery; 10 (59%) of the 17 patients with cholecystitis and 179 (67%) of the 266 patients without cholecystitis (p =0.47). Of the 15 patients with a cholecystostomy tube 5 (33%) did not complete neoadjuvant therapy and surgery. Both patients who had a cholecystectomy did not complete all neoadjuvant therapy and surgery. Of the 189 patients who completed all neoadjuvant therapy and surgery, the median time to surgery was 3.2 months for the 179 patients without cholecystitis and 3.6 months for the 10 patients with cholecystitis (p = 1.00).
Conclusion:
The development of acute cholecystitis during neoadjuvant therapy occurred in 6% of patients who had an endobiliary stent. The placement of a cholecystostomy tube for the management of acute cholecystitis does not significantly delay the completion of neoadjuvant therapy and surgery and should be considered the optimal management of this complication.