Digestive Surgery

Research Article

One-Step verse Step-Up Laparoscopic-Assisted Necrosectomy for Infected Pancreatic Necrosis

Cao F. · Duan N. · Gao C. · Li A. · Li F.

Author affiliations

Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China

Keywords: PancreatitisInfectionMinimal invasive surgeryNecrosectomy

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Dig Surg 2020;37:211–219
https://doi.org/10.1159/000501076

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Article / Publication Details

First-Page Preview
Abstract of Research Article

Received: November 11, 2018
Accepted: May 20, 2019
Published online: July 03, 2019
Issue release date: May 2020

Number of Print Pages: 9
Number of Figures: 2
Number of Tables: 3

ISSN: 0253-4886 (Print)
eISSN: 1421-9883 (Online)

For additional information: https://www.karger.com/DSU

Abstract

Background: Percutaneous or endoscopic drainage was usually performed as the first step in step-up approach for infected pancreatic necrosis (IPN). However, drainage was unnecessary or unavailable in some patients. Objective: To estimate the safety and effect of one-step laparoscopic-assisted necrosectomy in IPN patients. Methods: A retrospective analysis of IPN patients received surgical therapy in our center between January 2015 and December 2017 was performed. Patients were assigned to either one-step or step-up groups according to the received therapeutic approach. Incidence of complications, death, total number of interventions, and total hospital stay were compared. Logistic regression and nomogram were used to explore the risk factors and probability for patients undergoing interventions ≥3 times. Results: There were 45 and 49 patients included in one-step and step-up groups, respectively. No significant difference between groups in terms of new organ failure (14.29 vs. 14.33%, p = 0.832), death (8.89 vs.8.17%, p = 0.949), and long-term complications (18.37 vs. 15.56%, p = 0.717). However, the number of interventions in one-step group was significantly less than in step-up group with shorter hospital stay. After multivariate analysis, C-reactive protein, interleukin-6, and surgical approach were independent predicators for patients undergoing interventions ≥3. A nomogram was built with area under ROC curve 0.891. Conclusion: Compared with step-up approach, one-step surgery was safe and effective in selected IPN patients with less interventions and shorter hospital stay.

© 2019 S. Karger AG, Basel



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References

  1. Raraty MG, Halloran CM, Dodd S, Ghaneh P, Connor S, Evans J, et al. Minimal access retroperitoneal pancreatic necrosectomy: improvement in morbidity and mortality with a less invasive approach. Ann Surg. 2010 May;251(5):787–93.
  2. Gomatos IP, Halloran CM, Ghaneh P, Raraty MG, Polydoros F, Evans JC, et al. Outcomes from minimal access retroperitoneal and open pancreatic necrosectomy in 394 patients with necrotizing pancreatitis. Ann Surg. 2016 May;263(5):992–1001.
  3. Rodriguez JR, Razo AO, Targarona J, Thayer SP, Rattner DW, Warshaw AL, et al. Debridement and closed packing for sterile or infected necrotizing pancreatitis: insights into indications and outcomes in 167 patients. Ann Surg. 2008 Feb;247(2):294–9.
  4. Rasch S, Phillip V, Reichel S, Rau B, Zapf C, Rosendahl J, et al. Open surgical versus minimal invasive necrosectomy of the Pancreas-A retrospective multicenter analysis of the german pancreatitis study group. PLoS One. 2016 Sep;11(9):e0163651.
  5. Götzinger P, Sautner T, Kriwanek S, Beckerhinn P, Barlan M, Armbruster C, et al. Surgical treatment for severe acute pancreatitis: extent and surgical control of necrosis determine outcome. World J Surg. 2002 Apr;26(4):474–8.
  6. Rau B, Bothe A, Beger HG. Surgical treatment of necrotizing pancreatitis by necrosectomy and closed lavage: changing patient characteristics and outcome in a 19-year, single-center series. Surgery. 2005 Jul;138(1):28–39.
  7. Büchler MW, Gloor B, Müller CA, Friess H, Seiler CA, Uhl W. Acute necrotizing pancreatitis: treatment strategy according to the status of infection. Ann Surg. 2000 Nov;232(5):619–26.
  8. Ashley SW, Perez A, Pierce EA, Brooks DC, Moore FD Jr, Whang EE, et al. Necrotizing pancreatitis: contemporary analysis of 99 consecutive cases. Ann Surg. 2001 Oct;234(4):572–9; discussion 579–80.
  9. Besselink MG, van Santvoort HC, Nieuwenhuijs VB, Boermeester MA, Bollen TL, Buskens E, et al.; Dutch Acute Pancreatitis Study Group. Minimally invasive ‘step-up approach’ versus maximal necrosectomy in patients with acute necrotising pancreatitis (PANTER trial): design and rationale of a randomised controlled multicenter trial [ISRCTN13975868]. BMC Surg. 2006 Apr;6(1):6.
  10. van Santvoort HC, Besselink MG, Bakker OJ, Hofker HS, Boermeester MA, Dejong CH, et al.; Dutch Pancreatitis Study Group. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med. 2010 Apr;362(16):1491–502.
  11. Bakker OJ, van Santvoort HC, van Brunschot S, Geskus RB, Besselink MG, Bollen TL, et al.; Dutch Pancreatitis Study Group. Endoscopic transgastric vs surgical necrosectomy for infected necrotizing pancreatitis: a randomized trial. JAMA. 2012 Mar;307(10):1053–61.
  12. Nemoto Y, Attam R, Arain MA, Trikudanathan G, Mallery S, Beilman GJ, et al. Interventions for walled off necrosis using an algorithm based endoscopic step-up approach: outcomes in a large cohort of patients. Pancreatology. 2017 Sep-Oct;17(5):663–8.
  13. van Brunschot S, van Grinsven J, Voermans RP, Bakker OJ, Besselink MG, Boermeester MA, et al.; Dutch Pancreatitis Study Group. Transluminal endoscopic step-up approach versus minimally invasive surgical step-up approach in patients with infected necrotising pancreatitis (TENSION trial): design and rationale of a randomised controlled multicenter trial [ISRCTN09186711]. BMC Gastroenterol. 2013 Nov;13(1):161.
  14. Tenner S, Baillie J, DeWitt J, Vege SS; American College of Gastroenterology. American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol. 2013 Sep;108(9):1400–15.
  15. Yokoe M, Takada T, Mayumi T, Yoshida M, Isaji S, Wada K, et al. Japanese guidelines for the management of acute pancreatitis: japanese Guidelines 2015. J Hepatobiliary Pancreat Sci. 2015 Jun;22(6):405–32.
  16. Li A, Cao F, Li J, Fang Y, Wang X, Liu DG, et al. Step-up mini-invasive surgery for infected pancreatic necrosis: results from prospective cohort study. Pancreatology. 2016 Jul-Aug;16(4):508–14.
  17. van Brunschot S, van Grinsven J, van Santvoort HC, Bakker OJ, Besselink MG, Boermeester MA, et al.; Dutch Pancreatitis Study Group. Endoscopic or surgical step-up approach for infected necrotising pancreatitis: a multicentre randomised trial. Lancet. 2018 Jan;391(10115):51–8.
  18. He WH, Zhu Y, Zhu Y, Liu P, Zeng H, Xia L, et al. The outcomes of initial endoscopic transluminal drainage are superior to ­percutaneous drainage for patients with infected pancreatic necrosis: a prospective cohort study. Surg Endosc. 2017 Jul;31(7):3004–13.
  19. Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology. 2013 Jul-Aug;13(4 Suppl 2):e1–15.
  20. Connor S, Alexakis N, Raraty MG, Ghaneh P, Evans J, Hughes M, et al. Early and late complications after pancreatic necrosectomy. Surgery. 2005 May;137(5):499–505.
  21. Babu RY, Gupta R, Kang M, Bhasin DK, Rana SS, Singh R. Predictors of surgery in patients with severe acute pancreatitis managed by the step-up approach. Ann Surg. 2013 Apr;257(4):737–50.
  22. Hollemans RA, Bollen TL, van Brunschot S, Bakker OJ, Ahmed Ali U, van Goor H, et al.; Dutch Pancreatitis Study Group. Predicting success of catheter drainage in infected necrotizing pancreatitis. Ann Surg. 2016 Apr;263(4):787–92.
  23. Yoo J, Yan L, Hasan R, Somalya S, Nieto J, Siddiqui AA. Feasibility, safety, and outcomes of a single-step endoscopic ultrasonography-guided drainage of pancreatic fluid collections without fluoroscopy using a novel electrocautery-enhanced lumen-apposing, self-expanding metal stent. Endosc Ultrasound. 2017 Mar-Apr;6(2):131–5.
  24. Mangiavillano B, Arcidiacono PG, Masci E, Mariani A, Petrone MC, Carrara S, et al. Single-step versus two-step endo-ultrasonography-guided drainage of pancreatic pseudocyst. J Dig Dis. 2012 Jan;13(1):47–53.
  25. Heinzow HS, Meister T, Pfromm B, Lenze F, Domschke W, Ullerich H. Single-step versus multi-step transmural drainage of pancreatic pseudocysts: the use of cystostome is effective and timesaving. Scand J Gastroenterol. 2011 Jul;46(7–8):1004–13.

Article / Publication Details

First-Page Preview
Abstract of Research Article

Received: November 11, 2018
Accepted: May 20, 2019
Published online: July 03, 2019
Issue release date: May 2020

Number of Print Pages: 9
Number of Figures: 2
Number of Tables: 3

ISSN: 0253-4886 (Print)
eISSN: 1421-9883 (Online)

For additional information: https://www.karger.com/DSU

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2020, Vol.37, No. 3

May 2020

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