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1643. Image Guided Interventional Radiology (IR) Procedures in 308 Patients Status Post Whipple: Single Institution 10-year Experience
Authors * Denotes Presenting Author
  1. Neal Shah *; Case Western Reserve University
  2. Ruchika Podury; Case Western Reserve University
  3. Brandon DeClouette; Case Western Reserve University
  4. Sree Harsha Tirumani; Case Western Reserve University
  5. Nikhil Ramaiya; Case Western Reserve University
Objective:
To evaluate imaged-guided interventions in status post Whipple patients.

Materials and Methods:
Retrospective analysis of status post whipple patients was completed with a list obtained from the picture archiving and communications system with search term “pancreaticoduodenectomy OR whipple” from 01/2009 to 12/2018. The electronic health record was used to obtain data regarding demographics, pathology (adenocarcinoma, neuroendocrine tumor, benign entities), recurrence, mortality, and IR procedures (drain placement [DP], paracenteses [P], biopsys [Bx]).

Results:
308 patients (137 female, 171 male, median age 64.5) post-Whipple were analyzed. Pathologies were grouped into adenocarcinoma (191 patients, 62%), neuroendocrine (25, 8%), benign entities including IPMN and pancreatitis (71, 23%), and miscellaneous (21, 7%). The top 3 interventions performed were intraabdominal DP (158, 56.8%), P (50, 18%), and liver Bx (35, 12.6%). The most common microbes found in fluid were Enterococcus (19, 9.1%), Escherichia coli (11, 5.3%), and Enterobacter (9, 4.3%). 73 DP for 56 patients (94.8% of procedures), 27 DP for 16 patients (90%), 13 DP for 8 patients (29.5%), and 45 DP for 19 patients (35.4%) were placed 0-1 month, 1-3 months, 3-12 months, and 1 year or more post-Whipple, respectively. 0 P (0%), 2 P for 2 patients (6.7%), 14 P for 8 patients (31.8%), and 34 P for 15 patients (26.8%) were completed 0-1 month, 1-3 months, 3-12 months, and 1 year or more post-Whipple, respectively. 1 liver Bx for 1 patient (1.3 % of procedures), 1 liver Bx for 1 patient (3.3%), 12 liver Bx for 10 patients (27.3%), and 21 liver Bx for 17 patients (16.5%) were completed 0-1 month, 1-3 months, 3-12 months, and 1 year or more post-Whipple, respectively. Statistically, there was decreased overall survival (OS) in patients who underwent an increased frequency of total DP, P, and liver Bx (p<0.05).

Conclusion:
DP was the most common IR procedure performed in post-Whipple patients. An increased frequency of P and liver Bx correlated with decreased OS.