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Background Current guidelines advise the use of less aggressive procedures for the solution of cholecystitis in high risk patients. However, recent literature has shown better results in those patients managed with laparoscopic cholecystectomy . We aim to describe outcomes in high-risk patients with severe acute cholecystitis (Tokyo III) according to 2018 guidelines. MethodsPatients that underwent laparoscopic cholecystectomy and percutaneous drainage by cholecystostomy between January 2018 and January 2020 were included in descriptive analysis. Bivariate analysis of Tokyo III patients was performed between variables involved. Results A total of 622 patients were included. 54.66% of patients were female. The mean age was 66.6 ± 16.52 years. 288 patients were classified as grade III in Tokyo classification, 28.98% underwent cholecystostomy and 71.02% cholecystectomy. Mortality and complication rate had no significant differences between the groups (p = 0.09 - p = 0.1 respectively). The in-hospital length of stay was significantly higher in patients that required cholecystostomy with a mean of 15.43 days versus 9.97 days in the LC group, with a statistically significant difference (p 0.000 CI 95%) .ConclusionsLaparoscopic cholecystectomy seems to be a feasible treatment choice over percutaneous cholecystostomy in terms of mortality, reintervention and in-hospital stay length.

BackgroundAfter optimal management, 5 years survival of pancreatic cancer is 12 - 15%. Factors associated with poor prognosis are tumoral histology, harvested regional lymph nodes, and recently, hepatic artery lymph node HLA(8a) involvement. In fact, evidence has shown negative impact of node 8a involvement on overall survival and disease free-survival. Therefore, we aimed to describe the prognostic significance of the HLA(8a) lymph node metastasis in terms of disease-free survival (DFS) and overall survival (OS) on a specific cohort of patients.MethodsA retrospective study was conducted based on a prospective database from the HPB department of patients who underwent a pancreaticoduodenectomy (PD) due to pancreatic cancer during 2014 - 2021. Overall survival (OS) and disease-free survival (DFS) were estimated to be associated with positive HLA(8a) using Kaplan-Meier analysis. Log Rank test and Cox proportional hazards regression analysis were used. Results111 patients were included, 55,4% female. The most frequent pathology was ductal adenocarcinoma (60.3%). Positive rate of the HLA(8a) node was 21.62%. Median OS time was 25.5 months, and median DFS time was 13,8 months. Positive HLA(8a) node, the cutoff of lymph node ratio (LNR) resection, and vascular invasion showed a strong association with OS. (CoxRegression p = 0.03 HR 0.5, p 0.003 HR = 1.8, p = 0.02 HR 0.4 CI 95%). In terms of DFS, lymph node ratio cutoff, tumoral size, and vascular invasion showed a statistically significant association with the outcome (p = 0.008, HR = 1.5; p= 0.04 HR=2.1; p=0.02 HR=0.4 CI 95%).Conclusion In this series of pancreaticoduodenectomies, OS and DFS are significantly reduced in patients with HLA(8a) node compromise in patients with pancreatic cancer. In multivariate analysis, lymph node status remains an independent predictor of OS and DFS. Further studies are needed.