Zhihui Tong1, Xiao Shen1,2, Lu Ke3, Gang Li1, Jing Zhou1, Yiyuan Pan1, Baiqiang Li1, Dongliang Yang1, Weiqin Li4, Jieshou Li1. 1. Surgical Intensive Care Unit (SICU), Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Jinling Hospital, No. 305 East Zhongshan Road, Nanjing, 210002, People's Republic of China. 2. Intensive Care Unit (ICU), Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, People's Republic of China. 3. Surgical Intensive Care Unit (SICU), Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Jinling Hospital, No. 305 East Zhongshan Road, Nanjing, 210002, People's Republic of China. kkb9832@163.com. 4. Surgical Intensive Care Unit (SICU), Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Jinling Hospital, No. 305 East Zhongshan Road, Nanjing, 210002, People's Republic of China. njzy_pancrea@163.com.
Abstract
BACKGROUND: Step-up approach consisting of multiple minimally invasive techniques has gradually become the mainstream for managing infected pancreatic necrosis (IPN). In the present study, we aimed to compare the safety and efficacy of a novel four-step approach and the conventional approach in managing IPN. METHODS: According to the treatment strategy, consecutive patients fulfilling the inclusion criteria were put into two time intervals to conduct a before-and-after comparison: the conventional group (2010-2011) and the novel four-step group (2012-2013). The conventional group was essentially open necrosectomy for any patient who failed percutaneous drainage of infected necrosis. And the novel drainage approach consisted of four different steps including percutaneous drainage, negative pressure irrigation, endoscopic necrosectomy and open necrosectomy in sequence. The primary endpoint was major complications (new-onset organ failure, sepsis or local complications, etc.). Secondary endpoints included mortality during hospitalization, need of emergency surgery, duration of organ failure and sepsis, etc. RESULTS: Of the 229 recruited patients, 92 were treated with the conventional approach and the remaining 137 were managed with the novel four-step approach. New-onset major complications occurred in 72 patients (78.3%) in the two-step group and 75 patients (54.7%) in the four-step group (p < 0.001). For other important endpoints, although there was no statistical difference in mortality between the two groups (p = 0.403), significantly fewer patients in the four-step group required emergency surgery when compared with the conventional group [14.6% (20/137) vs. 45.6% (42/92), p < 0.001]. In addition, stratified analysis revealed that the four-step approach group presented significantly lower incidence of new-onset organ failure and other major complications in patients with the most severe type of AP. CONCLUSION: Comparing with the conventional approach, the novel four-step approach significantly reduced the rate of new-onset major complications and requirement of emergency operations in treating IPN, especially in those with the most severe type of acute pancreatitis.
BACKGROUND: Step-up approach consisting of multiple minimally invasive techniques has gradually become the mainstream for managing infected pancreatic necrosis (IPN). In the present study, we aimed to compare the safety and efficacy of a novel four-step approach and the conventional approach in managing IPN. METHODS: According to the treatment strategy, consecutive patients fulfilling the inclusion criteria were put into two time intervals to conduct a before-and-after comparison: the conventional group (2010-2011) and the novel four-step group (2012-2013). The conventional group was essentially open necrosectomy for any patient who failed percutaneous drainage of infected necrosis. And the novel drainage approach consisted of four different steps including percutaneous drainage, negative pressure irrigation, endoscopic necrosectomy and open necrosectomy in sequence. The primary endpoint was major complications (new-onset organ failure, sepsis or local complications, etc.). Secondary endpoints included mortality during hospitalization, need of emergency surgery, duration of organ failure and sepsis, etc. RESULTS: Of the 229 recruited patients, 92 were treated with the conventional approach and the remaining 137 were managed with the novel four-step approach. New-onset major complications occurred in 72 patients (78.3%) in the two-step group and 75 patients (54.7%) in the four-step group (p < 0.001). For other important endpoints, although there was no statistical difference in mortality between the two groups (p = 0.403), significantly fewer patients in the four-step group required emergency surgery when compared with the conventional group [14.6% (20/137) vs. 45.6% (42/92), p < 0.001]. In addition, stratified analysis revealed that the four-step approach group presented significantly lower incidence of new-onset organ failure and other major complications in patients with the most severe type of AP. CONCLUSION: Comparing with the conventional approach, the novel four-step approach significantly reduced the rate of new-onset major complications and requirement of emergency operations in treating IPN, especially in those with the most severe type of acute pancreatitis.
Authors: Michael G T Raraty; Christopher M Halloran; Susanna Dodd; Paula Ghaneh; Saxon Connor; Jonathan Evans; Robert Sutton; John P Neoptolemos Journal: Ann Surg Date: 2010-05 Impact factor: 12.969
Authors: Hjalmar C van Santvoort; Marc G Besselink; Olaf J Bakker; H Sijbrand Hofker; Marja A Boermeester; Cornelis H Dejong; Harry van Goor; Alexander F Schaapherder; Casper H van Eijck; Thomas L Bollen; Bert van Ramshorst; Vincent B Nieuwenhuijs; Robin Timmer; Johan S Laméris; Philip M Kruyt; Eric R Manusama; Erwin van der Harst; George P van der Schelling; Tom Karsten; Eric J Hesselink; Cornelis J van Laarhoven; Camiel Rosman; Koop Bosscha; Ralph J de Wit; Alexander P Houdijk; Maarten S van Leeuwen; Erik Buskens; Hein G Gooszen Journal: N Engl J Med Date: 2010-04-22 Impact factor: 91.245
Authors: J Ruben Rodriguez; A Oswaldo Razo; Javier Targarona; Sarah P Thayer; David W Rattner; Andrew L Warshaw; Carlos Fernández-del Castillo Journal: Ann Surg Date: 2008-02 Impact factor: 12.969
Authors: Sandra van Brunschot; Janneke van Grinsven; Rogier P Voermans; Olaf J Bakker; Marc G H Besselink; Marja A Boermeester; Thomas L Bollen; Koop Bosscha; Stefan A Bouwense; Marco J Bruno; Vincent C Cappendijk; Esther C Consten; Cornelis H Dejong; Marcel G W Dijkgraaf; Casper H van Eijck; G Willemien Erkelens; Harry van Goor; Mohammed Hadithi; Jan-Willem Haveman; Sijbrand H Hofker; Jeroen J M Jansen; Johan S Laméris; Krijn P van Lienden; Eric R Manusama; Maarten A Meijssen; Chris J Mulder; Vincent B Nieuwenhuis; Jan-Werner Poley; Rogier J de Ridder; Camiel Rosman; Alexander F Schaapherder; Joris J Scheepers; Erik J Schoon; Tom Seerden; B W Marcel Spanier; Jan Willem A Straathof; Robin Timmer; Niels G Venneman; Frank P Vleggaar; Ben J Witteman; Hein G Gooszen; Hjalmar C van Santvoort; Paul Fockens Journal: BMC Gastroenterol Date: 2013-11-25 Impact factor: 3.067
Authors: Lu Ke; Wenjian Mao; Jing Zhou; Bo Ye; Gang Li; Jingzhu Zhang; Peng Wang; Zhihui Tong; John Windsor; Weiqin Li Journal: World J Surg Date: 2019-04 Impact factor: 3.352
Authors: Gang Li; Lin Gao; Jing Zhou; Bo Ye; Jingzhu Zhang; Cheng Qu; Lu Ke; Zhihui Tong; Weiqin Li Journal: Gastroenterol Res Pract Date: 2019-07-01 Impact factor: 2.260