Outcomes From Minimal Access Retroperitoneal and Open Pancreatic Necrosectomy in 394 Patients With Necrotizing Pancreatitis



Gomatis, I, Halloran, CM ORCID: 0000-0002-5471-4178, Ghaneh, P, Raraty, M, Polydoros, F ORCID: 0000-0001-5181-6817, Evans, JC, Smart, HL, Yagati-Satchidanand, R, Garry, JM, Whelan, PA
et al (show 3 more authors) (2016) Outcomes From Minimal Access Retroperitoneal and Open Pancreatic Necrosectomy in 394 Patients With Necrotizing Pancreatitis. Annals of Surgery, 263 (5). 992 - 1001.

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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.

Item Type: Article
Uncontrolled Keywords: acute pancreatitis, interventional radiology, multi-organ system failure, pancreatic surgery, severe pancreatitis, step-up
Depositing User: Symplectic Admin
Date Deposited: 15 Mar 2017 14:27
Last Modified: 31 Aug 2022 15:14
DOI: 10.1097/SLA.0000000000001407
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3001931