Acute cholecystitis (AC) with concurrent cholangitis is a life-threatening condition in elderly patients. We aimed to investigate the outcome of cholecystectomy in patients aged ≥ 80 years with moderate to severe AC who underwent percutaneous cholecystostomy and subsequent interventional endoscopic retrograde cholangiopancreatography (ERCP). Between January 2008 and February 2021, we retrospectively enrolled 174 patients who underwent percutaneous cholecystostomy and subsequent ERCP at Taipei Veterans General Hospital. The patients were divided into cholecystectomy and non-cholecystectomy groups after discharge. Clinical outcomes including overall survival rate, recurrence rate of biliary-related events, and complications of ERCP and cholecystectomy, were analyzed. The Kaplan–Meier model was used to interpret the overall survival and cumulative recurrence rates. There were 34 patients receiving cholecystectomy (cholecystectomy group), and 98 patients received conservative treatment (non-cholecystectomy group). The overall mortality rate and biliary-related mortality did not differ between the cholecystectomy and non-cholecystectomy groups (20.5% vs. 35.7%, p = 0.082; and 0% vs. 3%, p = 0.083, respectively). The 1-year recurrent rate, 3-year recurrent rate and 5-year recurrence rates of biliary-related events were significantly lower in the cholecystectomy group than in the non-cholecystectomy group (2.9% vs. 18.4%, p = 0.002; 5.9% vs. 20.4%, p = 0.014; 8.8% vs. 24.5%, p = 0.02, respectively). There was no significant difference in the 1-year recurrence rates of cholangitis (2,9% vs. 6.1%, p = 0.407), and pancreatitis (0% vs. 1.0%, p = 0.320). The overall ERCP-related complication rate in the elderly population was low (4%). The overall rate of surgical complications was 11.8% in the cholecystectomy group. Cholecystectomy lowers the recurrence rate of biliary-related events in octogenarians with moderate-to-severe cholecystitis and concurrent cholangitis after percutaneous cholecystostomy and subsequent interventional ERCP.
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