The Effect of an Invasive Strategy for Treating Pancreatic Necrosis on Mortality: a Retrospective Multicenter Cohort Study

Kazuhiro Minami, Masayasu Horibe, Masamitsu Sanui, Mitsuhito Sasaki, Eisuke Iwasaki, Hirotaka Sawano, Takashi Goto, Tsukasa Ikeura, Tsuyoshi Takeda, Takuya Oda, Hideto Yasuda, Yuki Ogura, Dai Miyazaki, Katsuya Kitamura, Nobutaka Chiba, Tetsu Ozaki, Takahiro Yamashita, Toshitaka Koinuma, Taku Oshima, Tomonori YamamotoMorihisa Hirota, Natsuko Tokuhira, Yoshinori Azumi, Keiji Nagata, Kazunori Takeda, Tomoki Furuya, Alan Kawarai Lefor, Toshihiko Mayumi, Takanori Kanai

Research output: Contribution to journalArticle

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 languageEnglish
JournalJournal of Gastrointestinal Surgery
DOIs
Publication statusAccepted/In press - 2019 Jan 1

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Multicenter Studies
Cohort Studies
Necrosis
Mortality
Pancreatitis
Therapeutics
Odds Ratio
Confidence Intervals
Minimally Invasive Surgical Procedures
Pancreas
Japan
Multivariate Analysis

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 journalArticle

Minami, K, Horibe, M, Sanui, M, Sasaki, M, Iwasaki, E, Sawano, H, Goto, T, Ikeura, T, Takeda, T, Oda, T, Yasuda, H, Ogura, Y, Miyazaki, D, Kitamura, K, Chiba, N, Ozaki, T, Yamashita, T, Koinuma, T, Oshima, T, Yamamoto, T, Hirota, M, Tokuhira, N, Azumi, Y, Nagata, K, Takeda, K, Furuya, T, Lefor, AK, Mayumi, T & Kanai, T 2019, 'The Effect of an Invasive Strategy for Treating Pancreatic Necrosis on Mortality: a Retrospective Multicenter Cohort Study', Journal of Gastrointestinal Surgery. https://doi.org/10.1007/s11605-019-04333-7
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. / The Effect of an Invasive Strategy for Treating Pancreatic Necrosis on Mortality : a Retrospective Multicenter Cohort Study. In: Journal of Gastrointestinal Surgery. 2019.
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title = "The Effect of an Invasive Strategy for Treating Pancreatic Necrosis on Mortality: a Retrospective Multicenter Cohort Study",
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.",
keywords = "Acute necrotic collection, Necrosectomy, Necrotizing pancreatitis, Severe acute pancreatitis, Walled-off necrosis",
author = "Kazuhiro Minami and Masayasu Horibe and Masamitsu Sanui and Mitsuhito Sasaki and Eisuke Iwasaki and Hirotaka Sawano and Takashi Goto and Tsukasa Ikeura and Tsuyoshi Takeda and Takuya Oda and Hideto Yasuda and Yuki Ogura and Dai Miyazaki and Katsuya Kitamura and Nobutaka Chiba and Tetsu Ozaki and Takahiro Yamashita and Toshitaka Koinuma and Taku Oshima and Tomonori Yamamoto and Morihisa Hirota and Natsuko Tokuhira and Yoshinori Azumi and Keiji Nagata and Kazunori Takeda and Tomoki Furuya and Lefor, {Alan Kawarai} and Toshihiko Mayumi and Takanori Kanai",
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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

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