Outcomes From Minimal Access Retroperitoneal and Open Pancreatic Necrosectomy in 394 Patients With Necrotizing Pancreatitis. Issue 5 (May 2016)

• Record Type: Journal Article
• Authors: Gomatos, Ilias P.; Halloran, Christopher M.; Ghaneh, Paula; Raraty, Michael G.T.; Polydoros, Fotis; Evans, Jonathan C.; Smart, Howard L.; Yagati-Satchidanand, R.; Garry, Jo M.; Whelan, Philip A.; Hughes, Faye E.; Sutton, Robert; Neoptolemos, John P.
• Is Part Of: Annals of surgery. Volume 263:Issue 5(2016:May)
• Publication Date: 2016-05
• Subjects: acute pancreatitis -- interventional radiology -- multi-organ system failure -- pancreatic surgery -- severe pancreatitis -- step-up; Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000001407
• Languages: English
• ISSNs: 0003-4932

Abstract

Abstract : Objective: To examine the outcomes from minimal access retroperitoneal pancreatic necrosectomy (MARPN) and open pancreatic necrosectomy (OPN) for severe necrotizing pancreatitis in a single center. Background: The optimal management of severe pancreatic necrosis is evolving with a few large center single series. Methods: Between 1997 and 2013, patients with necrotizing pancreatitis at the Liverpool Pancreas Center were reviewed. Outcome measures were retrospectively analyzed by intention to treat. Results: There were 394 patients who had either MARPN (274, 69.5%) or OPN (120, 30.5%). Complications occurred in 174 MARPN patients (63.5%) and 98 (81.7%) OPN patients ( P < 0.001). OPN was associated with increased postoperative multiorgan failure [42 (35%) vs 56 (20.4%), P = 0.001] and median (inter-quartile range) Acute Physiology and Chronic Health Evaluation II score 9 (6–11.5) vs 8 (5–11), P < 0.001] with intensive care required less frequently in MARPN patients [40.9% (112) vs 75% (90), P < 0.001]. The mortality rate was 42 (15.3%) in MARPNs and 28 (23.3%) in OPNs ( P = 0.064). Both the mortality and the overall complication rates decreased between 1997–2008 and 2008–2013 [49 (23.8%) vs 21 (11.2%) P = 0.001, respectively; and 151 (73.3%) vs 121 (64.4%), P = 0.080, respectively). Increased mortality was independently associated with age ( P < 0.001), preoperative intensive care stay ( P = 0.014), and multiple organ failure ( P < 0.001); operation before 2008 ( P < 0.001) and conversion to OPN ( P = 0.035). MARPN independently reduced mortality odds risk (odds ratio = 0.27; 95% confidence interval = 0.12–0.57; P < 0.001). Conclusions: Increasing experience and advances in perioperative care have led to improvement in outcomes. The role of MARPN in reducing complications and deaths within a multimodality approach remains substantial and should be used initially if feasible.