Abstract
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.
| Original language | English |
|---|---|
| Journal | Journal of Gastrointestinal Surgery |
| DOIs | |
| Publication status | Accepted/In press - 2019 Jan 1 |
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Keywords
- Acute necrotic collection
- Necrosectomy
- Necrotizing pancreatitis
- Severe acute pancreatitis
- Walled-off necrosis
ASJC Scopus subject areas
- Surgery
- Gastroenterology
Cite this
The Effect of an Invasive Strategy for Treating Pancreatic Necrosis on Mortality : a Retrospective Multicenter Cohort Study. / Minami, Kazuhiro; Horibe, Masayasu; Sanui, Masamitsu; Sasaki, Mitsuhito; Iwasaki, Eisuke; Sawano, Hirotaka; Goto, Takashi; Ikeura, Tsukasa; Takeda, Tsuyoshi; Oda, Takuya; Yasuda, Hideto; Ogura, Yuki; Miyazaki, Dai; Kitamura, Katsuya; Chiba, Nobutaka; Ozaki, Tetsu; Yamashita, Takahiro; Koinuma, Toshitaka; Oshima, Taku; Yamamoto, Tomonori; Hirota, Morihisa; Tokuhira, Natsuko; Azumi, Yoshinori; Nagata, Keiji; Takeda, Kazunori; Furuya, Tomoki; Lefor, Alan Kawarai; Mayumi, Toshihiko; Kanai, Takanori.
In: Journal of Gastrointestinal Surgery, 01.01.2019.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - The Effect of an Invasive Strategy for Treating Pancreatic Necrosis on Mortality
T2 - a Retrospective Multicenter Cohort Study
AU - Minami, Kazuhiro
AU - Horibe, Masayasu
AU - Sanui, Masamitsu
AU - Sasaki, Mitsuhito
AU - Iwasaki, Eisuke
AU - Sawano, Hirotaka
AU - Goto, Takashi
AU - Ikeura, Tsukasa
AU - Takeda, Tsuyoshi
AU - Oda, Takuya
AU - Yasuda, Hideto
AU - Ogura, Yuki
AU - Miyazaki, Dai
AU - Kitamura, Katsuya
AU - Chiba, Nobutaka
AU - Ozaki, Tetsu
AU - Yamashita, Takahiro
AU - Koinuma, Toshitaka
AU - Oshima, Taku
AU - Yamamoto, Tomonori
AU - Hirota, Morihisa
AU - Tokuhira, Natsuko
AU - Azumi, Yoshinori
AU - Nagata, Keiji
AU - Takeda, Kazunori
AU - Furuya, Tomoki
AU - Lefor, Alan Kawarai
AU - Mayumi, Toshihiko
AU - Kanai, Takanori
PY - 2019/1/1
Y1 - 2019/1/1
N2 - 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.
AB - 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.
KW - Acute necrotic collection
KW - Necrosectomy
KW - Necrotizing pancreatitis
KW - Severe acute pancreatitis
KW - Walled-off necrosis
UR - http://www.scopus.com/inward/record.url?scp=85071162090&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85071162090&partnerID=8YFLogxK
U2 - 10.1007/s11605-019-04333-7
DO - 10.1007/s11605-019-04333-7
M3 - Article
AN - SCOPUS:85071162090
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
SN - 1091-255X
ER -