OBJECTIVE: To examine the surgical indications and clinical outcomes of a large cohort of patients with necrotizing pancreatitis. SUMMARY BACKGROUND DATA: Mortality after debridement for necrotizing pancreatitis continues to be inordinately high. The clinical experience with patients who underwent uniform surgical treatment for necrotizing pancreatitis at the Massachusetts General Hospital over a 15-year period is described. METHODS: Retrospective review of 167 patients with necrotizing pancreatitis who required intervention and were treated with single stage debridement and a closed packing technique. Particular emphasis was placed on the indication for surgery and the presence of infected necrosis. Multiple logistic regression models were used to identify predictors of mortality. RESULTS: The primary preoperative indication for operation was infected necrosis (51%), but intraoperative cultures proved that 72% of the entire cohort was infected. The rate of reoperation was 12.6%, and 29.9% of patients required percutaneous interventional radiology drainage after initial debridement. Overall operative mortality was 11.4% (19/167), but higher in patients who were operated upon before 28 days (20.3% vs. 5.1%, P = 0.002). Other important predictors of mortality included organ failure > or =3 (OR = 2.4, P = 0.001), postoperative intensive care unit stay > or =6 days (OR = 15.9, P = 0.001), and female gender (OR = 5.41, P = 0.02). CONCLUSIONS: Open, transperitoneal debridement followed by closed packing and drainage results in the lowest reported mortality and reoperation rates, and provides a standard for comparing other methods of treatment. A negative FNA does not reliably rule out infection. The clinical status of the patients and not proof of infection should determine the need for debridement.
OBJECTIVE: To examine the surgical indications and clinical outcomes of a large cohort of patients with necrotizing pancreatitis. SUMMARY BACKGROUND DATA: Mortality after debridement for necrotizing pancreatitis continues to be inordinately high. The clinical experience with patients who underwent uniform surgical treatment for necrotizing pancreatitis at the Massachusetts General Hospital over a 15-year period is described. METHODS: Retrospective review of 167 patients with necrotizing pancreatitis who required intervention and were treated with single stage debridement and a closed packing technique. Particular emphasis was placed on the indication for surgery and the presence of infected necrosis. Multiple logistic regression models were used to identify predictors of mortality. RESULTS: The primary preoperative indication for operation was infected necrosis (51%), but intraoperative cultures proved that 72% of the entire cohort was infected. The rate of reoperation was 12.6%, and 29.9% of patients required percutaneous interventional radiology drainage after initial debridement. Overall operative mortality was 11.4% (19/167), but higher in patients who were operated upon before 28 days (20.3% vs. 5.1%, P = 0.002). Other important predictors of mortality included organ failure > or =3 (OR = 2.4, P = 0.001), postoperative intensive care unit stay > or =6 days (OR = 15.9, P = 0.001), and female gender (OR = 5.41, P = 0.02). CONCLUSIONS: Open, transperitoneal debridement followed by closed packing and drainage results in the lowest reported mortality and reoperation rates, and provides a standard for comparing other methods of treatment. A negative FNA does not reliably rule out infection. The clinical status of the patients and not proof of infection should determine the need for debridement.
Authors: Waldemar Uhl; Andrew Warshaw; Clement Imrie; Claudio Bassi; Colin J McKay; Paul G Lankisch; Ross Carter; Eugene Di Magno; Peter A Banks; David C Whitcomb; Christos Dervenis; Charles D Ulrich; Kat Satake; Paula Ghaneh; Werner Hartwig; Jens Werner; Gerry McEntee; John P Neoptolemos; Markus W Büchler Journal: Pancreatology Date: 2002 Impact factor: 3.996
Authors: Werner Hartwig; Sasa-Marcel Maksan; Thomas Foitzik; Jan Schmidt; Christian Herfarth; Ernst Klar Journal: J Gastrointest Surg Date: 2002 May-Jun Impact factor: 3.452
Authors: S Connor; P Ghaneh; M Raraty; R Sutton; E Rosso; C J Garvey; M L Hughes; J C Evans; P Rowlands; J P Neoptolemos Journal: Dig Surg Date: 2003-05-15 Impact factor: 2.588
Authors: Thomas J Howard; Jay B Patel; Nicholas Zyromski; Kumar Sandrasegaran; Jian Yu; Atilla Nakeeb; Henry A Pitt; Keith D Lillemoe Journal: J Gastrointest Surg Date: 2007-01 Impact factor: 3.452
Authors: Douglas G Adler; Suresh T Chari; Tamela J Dahl; Michael B Farnell; Randall K Pearson Journal: Am J Gastroenterol Date: 2003-01 Impact factor: 10.864
Authors: Christopher C Stahl; Jonathan Moulton; Doan Vu; Ross Ristagno; Kyuran Choe; Jeffrey J Sussman; Shimul A Shah; Syed A Ahmad; Daniel E Abbott Journal: Surgery Date: 2015-08-10 Impact factor: 3.982
Authors: Janneke van Grinsven; Hjalmar C van Santvoort; Marja A Boermeester; Cornelis H Dejong; Casper H van Eijck; Paul Fockens; Marc G Besselink Journal: Nat Rev Gastroenterol Hepatol Date: 2016-03-09 Impact factor: 46.802