Open Surgical versus Minimal Invasive Necrosectomy of the Pancreas—A Retrospective Multicenter Analysis of the German Pancreatitis Study Group

PLoS One

Stephanie Reichel¹  Jochen Hampe²  Werner Hartwig²  Albrecht Neesse³  Ernst Klar³  Uwe Will⁴  Volker Ellenrieder⁴  Stefan Post⁵  Bettina Rau⁵  Joachim Mössner⁶  Hana Algül⁶  Martin Müller⁷  Alexander Kleger⁷  Jens Werner⁷  Mark Ellrichmann⁸  Peter Strauß⁹  Thomas M. Gress⁹  Felix Rückert⁹  Markus Zachäus^1,10  Ulrich Halm^1,10  Thomas Seufferlein^1,11  Alexander Arlt^1,11  Christian Zapf^1,12  Roland M. Schmid^1,12  Jonas Rosendahl^1,12  Marco Siech^1,13  Veit Phillip^1,13  Sebastian Rasch^1,13 

[1] Department for Gastroenterology, SRH Wald-Klinikum Gera, Gera, Germany;Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center Goettingen, Goettingen, Germany;Department of Gastroenterology, Endocrinology, Infectiology and Metabolism, Philipps-University, Marburg, Germany;Department of General and Vascular Surgery, Ostalb-Klinikum Aalen, Aalen, Germany;Department of General, Thoracic, Vascular and Transplantation Surgery, University of Rostock, Rostock, Germany;Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Hospital of the University of Munich, München, Germany;Department of Internal Medicine I, Ulm University, Ulm, Germany;Department of Internal Medicine I, University Hospital Dresden, Dresden University of Technology, Dresden, Germany;Department of Internal Medicine I, University Hospital Schleswig-Holstein, Kiel, Germany;Department of Internal Medicine II, HELIOS Park-Klinikum, Leipzig, Germany;Department of Surgery, University Hospital Mannheim, University of Heidelberg, Heidelberg, Germany;Division of Gastroenterology and Rheumatology, Department of Internal Medicine, Neurology and Dermatology, University of Leipzig, Leipzig, Germany;II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Germany

关键词: Pancreatitis;    Surgical and invasive medical procedures;    Death rates;    Minimally invasive surgery;    Necrosis;    Endoscopy;    Morbidity;    Hematocrit;   

DOI  :  10.1371/journal.pone.0163651

学科分类：医学（综合）

来源: Public Library of Science

【 摘 要 】

Background Necrotising pancreatitis, and particularly infected necrosis, are still associated with high morbidity and mortality. Since 2011, a step-up approach with lower morbidity rates compared to initial open necrosectomy has been established. However, mortality and complication rates of this complex treatment are hardly studied thereafter. Methods The German Pancreatitis Study Group performed a multicenter, retrospective study including 220 patients with necrotising pancreatitis requiring intervention, treated at 10 hospitals in Germany between January 2008 and June 2014. Data were analysed for the primary endpoints "severe complications" and "mortality" as well as secondary endpoints including "length of hospital stay", "follow up", and predisposing or prognostic factors. Results Of all patients 13.6% were treated primarily with surgery and 86.4% underwent a step-up approach. More men (71.8%) required intervention for necrotising pancreatitis. The most frequent etiology was biliary (41.4%) followed by alcohol (29.1%). Compared to open necrosectomy, the step-up approach was associated with a lower number of severe complications (primary composite endpoint including sepsis, persistent multiorgan dysfunction syndrome (MODS) and erosion bleeding: 44.7% vs. 73.3%), lower mortality (10.5% vs. 33.3%) and lower rates of diabetes mellitus type 3c (4.7% vs. 33.3%). Low hematocrit and low blood urea nitrogen at admission as well as a history of acute pancreatitis were prognostic for less complications in necrotising pancreatitis. A combination of drainage with endoscopic necrosectomy resulted in the lowest rate of severe complications. Conclusion A step-up approach starting with minimal invasive drainage techniques and endoscopic necrosectomy results in a significant reduction of morbidity and mortality in necrotising pancreatitis compared to a primarily surgical intervention.

【 授权许可】

CC BY