TY - JOUR
T1 - Open surgical versus minimal invasive necrosectomy of the pancreas - A retrospective multicenter analysis of the German pancreatitis study group
AU - Rasch, Sebastian
AU - Phillip, Veit
AU - Reichel, Stephanie
AU - Rau, Bettina
AU - Zapf, Christian
AU - Rosendahl, Jonas
AU - Halm, Ulrich
AU - Zachäus, Markus
AU - Müller, Martin
AU - Kleger, Alexander
AU - Neesse, Albrecht
AU - Hampe, Jochen
AU - Ellrichmann, Mark
AU - Rückert, Felix
AU - Strauß, Peter
AU - Arlt, Alexander
AU - Ellenrieder, Volker
AU - Gress, Thomas M.
AU - Hartwig, Werner
AU - Klar, Ernst
AU - Mössner, Joachim
AU - Post, Stefan
AU - Schmid, Roland M.
AU - Seufferlein, Thomas
AU - Siech, Marco
AU - Werner, Jens
AU - Will, Uwe
AU - Algül, Hana
N1 - Publisher Copyright:
© 2016 Rasch et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2016/9
Y1 - 2016/9
N2 - Background: Necrotising pancreatitis, and particularly infected necrosis, are still associated with high morbidity and mortality. Since 2011, a step-up approach with lower morbidity rates compared to initial open necrosectomy has been established. However, mortality and complication rates of this complex treatment are hardly studied thereafter. Methods: The German Pancreatitis Study Group performed a multicenter, retrospective study including 220 patients with necrotising pancreatitis requiring intervention, treated at 10 hospitals in Germany between January 2008 and June 2014. Data were analysed for the primary endpoints "severe complications" and "mortality" as well as secondary endpoints including "length of hospital stay", "follow up", and predisposing or prognostic factors. Results: Of all patients 13.6% were treated primarily with surgery and 86.4% underwent a step-up approach. More men (71.8%) required intervention for necrotising pancreatitis. The most frequent etiology was biliary (41.4%) followed by alcohol (29.1%). Compared to open necrosectomy, the step-up approach was associated with a lower number of severe complications (primary composite endpoint including sepsis, persistent multiorgan dysfunction syndrome (MODS) and erosion bleeding: 44.7% vs. 73.3%), lower mortality (10.5% vs. 33.3%) and lower rates of diabetes mellitus type 3c (4.7% vs. 33.3%). Low hematocrit and low blood urea nitrogen at admission as well as a history of acute pancreatitis were prognostic for less complications in necrotising pancreatitis. A combination of drainage with endoscopic necrosectomy resulted in the lowest rate of severe complications. Conclusion: A step-up approach starting with minimal invasive drainage techniques and endoscopic necrosectomy results in a significant reduction of morbidity and mortality in necrotising pancreatitis compared to a primarily surgical intervention.
AB - Background: Necrotising pancreatitis, and particularly infected necrosis, are still associated with high morbidity and mortality. Since 2011, a step-up approach with lower morbidity rates compared to initial open necrosectomy has been established. However, mortality and complication rates of this complex treatment are hardly studied thereafter. Methods: The German Pancreatitis Study Group performed a multicenter, retrospective study including 220 patients with necrotising pancreatitis requiring intervention, treated at 10 hospitals in Germany between January 2008 and June 2014. Data were analysed for the primary endpoints "severe complications" and "mortality" as well as secondary endpoints including "length of hospital stay", "follow up", and predisposing or prognostic factors. Results: Of all patients 13.6% were treated primarily with surgery and 86.4% underwent a step-up approach. More men (71.8%) required intervention for necrotising pancreatitis. The most frequent etiology was biliary (41.4%) followed by alcohol (29.1%). Compared to open necrosectomy, the step-up approach was associated with a lower number of severe complications (primary composite endpoint including sepsis, persistent multiorgan dysfunction syndrome (MODS) and erosion bleeding: 44.7% vs. 73.3%), lower mortality (10.5% vs. 33.3%) and lower rates of diabetes mellitus type 3c (4.7% vs. 33.3%). Low hematocrit and low blood urea nitrogen at admission as well as a history of acute pancreatitis were prognostic for less complications in necrotising pancreatitis. A combination of drainage with endoscopic necrosectomy resulted in the lowest rate of severe complications. Conclusion: A step-up approach starting with minimal invasive drainage techniques and endoscopic necrosectomy results in a significant reduction of morbidity and mortality in necrotising pancreatitis compared to a primarily surgical intervention.
UR - http://www.scopus.com/inward/record.url?scp=84992345072&partnerID=8YFLogxK
U2 - 10.1371/journal.pone.0163651
DO - 10.1371/journal.pone.0163651
M3 - Article
AN - SCOPUS:84992345072
SN - 1932-6203
VL - 11
JO - PLoS ONE
JF - PLoS ONE
IS - 9
M1 - e0163651
ER -
