The Effect of an Invasive Strategy for Treating Pancreatic Necrosis on Mortality: a Retrospective Multicenter Cohort Study.
Acute necrotic collection
Necrosectomy
Necrotizing pancreatitis
Severe acute pancreatitis
Walled-off necrosis
Journal
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
ISSN: 1873-4626
Titre abrégé: J Gastrointest Surg
Pays: United States
ID NLM: 9706084
Informations de publication
Date de publication:
09 2020
09 2020
Historique:
received:
24
01
2019
accepted:
16
07
2019
pubmed:
21
8
2019
medline:
15
4
2021
entrez:
21
8
2019
Statut:
ppublish
Résumé
Infected acute necrotic collections (ANC) and walled-off necrosis (WON) of the pancreas are associated with high mortality. The difference in mortality between open necrosectomy and minimally invasive therapies in these patients remains unclear. This retrospective multicenter cohort study was conducted among 44 institutions in Japan from 2009 to 2013. Patients who had undergone invasive treatment for suspected infected ANC/WON were enrolled and classified into open necrosectomy and minimally invasive treatment (laparoscopic, percutaneous, and endoscopic) groups. The association of each treatment with mortality was evaluated and compared. Of 1159 patients with severe acute pancreatitis, 122 with suspected infected ANC or WON underwent the following treatments: open necrosectomy (33) and minimally invasive treatment (89), (laparoscopic three, percutaneous 49, endoscopic 37). Although the open necrosectomy group had a significantly higher mortality on univariate analysis (p = 0.047), multivariate analysis showed no significant associations between open necrosectomy or Charlson index and mortality (p = 0.29, p = 0.19, respectively). However, age (for each additional 10 years, p = 0.012, odds ratio [OR] 1.50, 95% confidence interval [CI] 1.09-2.06) and revised Atlanta criteria-severe (p = 0.001, OR 7.84, 95% CI 2.40-25.6) were significantly associated with mortality. In patients with acute pancreatitis and infected ANC/WON, age and revised Atlanta criteria-severe classification are significantly associated with mortality whereas open necrosectomy is not. The mortality risk for patients undergoing open necrosectomy and minimally invasive treatment does not differ significantly. Although minimally invasive surgery is generally preferred for patients with infected ANC/WON, open necrosectomy may be considered if clinically indicated.
Sections du résumé
BACKGROUND
Infected acute necrotic collections (ANC) and walled-off necrosis (WON) of the pancreas are associated with high mortality. The difference in mortality between open necrosectomy and minimally invasive therapies in these patients remains unclear.
METHODS
This retrospective multicenter cohort study was conducted among 44 institutions in Japan from 2009 to 2013. Patients who had undergone invasive treatment for suspected infected ANC/WON were enrolled and classified into open necrosectomy and minimally invasive treatment (laparoscopic, percutaneous, and endoscopic) groups. The association of each treatment with mortality was evaluated and compared.
RESULTS
Of 1159 patients with severe acute pancreatitis, 122 with suspected infected ANC or WON underwent the following treatments: open necrosectomy (33) and minimally invasive treatment (89), (laparoscopic three, percutaneous 49, endoscopic 37). Although the open necrosectomy group had a significantly higher mortality on univariate analysis (p = 0.047), multivariate analysis showed no significant associations between open necrosectomy or Charlson index and mortality (p = 0.29, p = 0.19, respectively). However, age (for each additional 10 years, p = 0.012, odds ratio [OR] 1.50, 95% confidence interval [CI] 1.09-2.06) and revised Atlanta criteria-severe (p = 0.001, OR 7.84, 95% CI 2.40-25.6) were significantly associated with mortality.
CONCLUSIONS
In patients with acute pancreatitis and infected ANC/WON, age and revised Atlanta criteria-severe classification are significantly associated with mortality whereas open necrosectomy is not. The mortality risk for patients undergoing open necrosectomy and minimally invasive treatment does not differ significantly. Although minimally invasive surgery is generally preferred for patients with infected ANC/WON, open necrosectomy may be considered if clinically indicated.
Identifiants
pubmed: 31428962
doi: 10.1007/s11605-019-04333-7
pii: 10.1007/s11605-019-04333-7
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
2037-2045Références
Yadav D, Lowenfels AB. The epidemiology of pancreatitis and pancreatic cancer. Gastroenterology 2013;144:1252–61.
doi: 10.1053/j.gastro.2013.01.068
Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013;62:102–11.
doi: 10.1136/gutjnl-2012-302779
Bruno MJ. Improving the Outcome of Acute Pancreatitis. Dig Dis 2016;34:540–5.
doi: 10.1159/000445257
Hackert T, Buchler MW. Decision Making in Necrotizing Pancreatitis. Dig Dis 2016;34:517–24.
doi: 10.1159/000445232
Sarathi Patra P, Das K, Bhattacharyya A, et al. Natural resolution or intervention for fluid collections in acute severe pancreatitis. Br J Surg 2014;101:1721–8.
doi: 10.1002/bjs.9666
Banks PA, Freeman ML. Practice guidelines in acute pancreatitis. Am J Gastroenterol 2006;101:2379–400.
doi: 10.1111/j.1572-0241.2006.00856.x
Bugiantella W, Rondelli F, Boni M, et al. Necrotizing pancreatitis: A review of the interventions. International journal of surgery (London, England) 2016;28 Suppl 1:S163–71.
doi: 10.1016/j.ijsu.2015.12.038
van Santvoort HC, Besselink MG, Bakker OJ, et al. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med 2010;362:1491–502.
doi: 10.1056/NEJMoa0908821
Bakker OJ, van Santvoort HC, van Brunschot S, et al. Endoscopic transgastric vs surgical necrosectomy for infected necrotizing pancreatitis: a randomized trial. Jama 2012;307:1053–61.
doi: 10.1001/jama.2012.276
Isayama H, Nakai Y, Rerknimitr R, et al. Asian consensus statements on endoscopic management of walled-off necrosis. Part 2: Endoscopic management. Journal of gastroenterology and hepatology 2016;31:1555–65.
doi: 10.1111/jgh.13398
Horibe M, Sasaki M, Sanui M, et al. Continuous Regional Arterial Infusion of Protease Inhibitors Has No Efficacy in the Treatment of Severe Acute Pancreatitis: A Retrospective Multicenter Cohort Study. Pancreas 2017;46:510–17.
doi: 10.1097/MPA.0000000000000775
Ikeura T, Horibe M, Sanui M, et al. Validation of the efficacy of the prognostic factor score in the Japanese severity criteria for severe acute pancreatitis: A large multicenter study. United European gastroenterology journal 2017;5:389–97.
doi: 10.1177/2050640616670566
Yang CJ, Chen J, Phillips AR, et al. Predictors of severe and critical acute pancreatitis: a systematic review. Dig. Liver Dis. 2014; 46:446–51.
doi: 10.1016/j.dld.2014.01.158
Mounzer R, Langmead CJ, Wu BU, et al. Comparison of existing clinical scoring systems to predict persistent organ failure in patients with acute pancreatitis. Gastroenterology 2012; 142: 1476–82.
doi: 10.1053/j.gastro.2012.03.005
Forsmark CE, Vege SS, Wilcox CM. Acute Pancreatitis. The New England journal of medicine 2016;375:1972–81.
doi: 10.1056/NEJMra1505202
Choi JH, Kim MH, Oh D, et al. Clinical relevance of the revised Atlanta classification focusing on severity stratification system. Pancreatology : official journal of the International Association of Pancreatology (IAP) [et al] 2014;14:324–9.
von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for reporting observational studies. International journal of surgery 2014;12:1495–9.
doi: 10.1016/j.ijsu.2014.07.013
Zerem E, Imamovic G, Susic A, Haracic B. Step-up approach to infected necrotising pancreatitis: a 20-year experience of percutaneous drainage in a single centre. Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver 2011;43:478–83.
doi: 10.1016/j.dld.2011.02.020
Tong Z, Li W, Yu W, et al. Percutaneous catheter drainage for infective pancreatic necrosis: is it always the first choice for all patients? Pancreas 2012;41:302–5.
doi: 10.1097/MPA.0b013e318229816f
van Brunschot S, van Grinsven J, van Santvoort HC, et al. Endoscopic or surgical step-up approach for infected necrotising pancreatitis: a multicentre randomised trial. Lancet 2018;391:51–8.
doi: 10.1016/S0140-6736(17)32404-2
IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology : official journal of the International Association of Pancreatology (IAP) [et al] 2013;13:e1–15.
van Brunschot S, Hollemans RA, Bakker OJ, et al. Minimally invasive and endoscopic versus open necrosectomy for necrotising pancreatitis: a pooled analysis of individual data for 1980 patients. Gut 2018;67:697–706.
pubmed: 28774886
Besselink MG, Verwer TJ, Schoemaeckers EJ, et al. Timing of surgical intervention in necrotizing pancreatitis. Arch. Surg. 2007; 142: 1194–201.
doi: 10.1001/archsurg.142.12.1194
Bausch D, Wellner U, Kahl S, et al. Minimally invasive operations for acute necrotizing pancreatitis: comparison of minimally invasive retroperitoneal necrosectomy with endoscopic transgastric necrosectomy. Surgery 2012;152:S128–34.
doi: 10.1016/j.surg.2012.05.021
Pascual I, Sabater L, Anon R, et al. Surgical versus nonsurgical treatment of infected pancreatic necrosis: more arguments to change the paradigm. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 2013;17:1627–33.
doi: 10.1007/s11605-013-2266-6
van Santvoort HC, Bakker OJ, Bollen TL, et al. A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome. Gastroenterology 2011;141:1254–63.
doi: 10.1053/j.gastro.2011.06.073