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
N1 - Funding Information:
We would like to acknowledge the support given by Kazuichi Okazaki, Tsuyoshi Hamada, Seiya Suzuki, Jun Kataoka, Tomohiro Adachi, Shin Namiki, Kaoru Hirose, Sakue Masuda, Tomoaki Hashida, Naoki Shinyama, Hitoshi Yamamura, Takashi Moriya, Kunihiro Shirai, Kazuo Inui, Satoshi Yamamoto, Kyoji Oe, Takashi Muraki, Tetsuya Ito, Yukiko Masuda, Junichi Sakagami, Hiroaki Yasuda, Yusuke Iizawa, Masayuki Kamochi, Nobuyuki Saito, Mizuki Sato, Kyohei Miyamoto, Mioko Kobayashi, Koji Saito, Shinjiro Saito, Junko Izai, Motohiro Sekino, Yoshimoto Seki, Tetsuya Mine, Youhei Kawashima, Naoyuki Matsuda, Masato Inaba, Mineji Hayakawa, Takuyo Misumi, and Yuki Takeda in data collection at the 44 participating institutions (Osaka Saiseikai Senri Hospital, Hiroshima City Hiroshima Citizens Hospital, Kansai Medical University Hirakata Hospital, The University of Tokyo Hospital, Iizuka Hospital, Japanese Red Cross Musashino Hospital, Tokyo Metropolitan Tama Medical Center, Japanese Redcross Maebashi Hospital, Shonan Kamakura General Hospital, Showa University Hospital, Nihon University Hospital, Saiseikai Kumamoto Hospital, Fukuyama City Hospital, Jichi Medical University Hospital, Chiba University Hospital, Osaka City University Hospital, Tohoku University Hospital, Nihon University Itabashi Hospital, Gifu University Hospital, Second Teaching Hospital, Fujita Health University, Asahi General Hospital, Shinshu University Hospital, National Hospital Organization Nagasaki Medical Center, University Hospital, Kyoto Prefectural University of Medicine, Mie University Hospital, Hospital of the University of Occupational and Environmental Health, Nippon Medical School Chiba Hokusoh Hospital, Jichi Medical University, Saitama Medical Center, Wakayama Medical University Hospital, Tokyo Metropolitan Bokutoh Hospital, Jikei University School of Medicine, Saka General Hospital, National Hospital Organization Sendai Medical Center, Nagasaki University Hospital, Keio University School of Medicine, Japanese Red Cross Akita Hospital, Ibaraki Prefectural Central Hospital, Tokai University Hospital, Nagoya University Hospital, Hokkaido University Hospital, National Cancer Center, Akita City Hospital, Kobe University Hospital, and Tokyo Rosai Hospital). We also thank the Japanese Society of Education for Physicians and Trainees in Intensive Care and the Japanese Society of Intensive Care Medicine. Additionally, we thank Dr. Trish Reynolds, MBBS, FRACP, from Edanz Group (www.edanzediting.com/ac) for editing the English text of a draft of this manuscript.
Publisher Copyright:
© 2019, The Society for Surgery of the Alimentary Tract.
PY - 2020/9/1
Y1 - 2020/9/1
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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U2 - 10.1007/s11605-019-04333-7
DO - 10.1007/s11605-019-04333-7
M3 - Article
C2 - 31428962
AN - SCOPUS:85071162090
VL - 24
SP - 2037
EP - 2045
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
SN - 1091-255X
IS - 9
ER -