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 journalArticlepeer-review

1 Citation (Scopus)

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
Pages (from-to)2037-2045
Number of pages9
JournalJournal of Gastrointestinal Surgery
Volume24
Issue number9
DOIs
Publication statusPublished - 2020 Sep 1

Keywords

  • Acute necrotic collection
  • Necrosectomy
  • Necrotizing pancreatitis
  • Severe acute pancreatitis
  • Walled-off necrosis

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

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