Open Surgical versus Minimal Invasive Necrosectomy of the Pancreas-A Retrospective Multicenter Analysis of the German Pancreatitis Study Group.
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 treatm...
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doaj-e840e70fa094454ab757433d017cf08c2020-11-25T01:42:03ZengPublic Library of Science (PLoS)PLoS ONE1932-62032016-01-01119e016365110.1371/journal.pone.0163651Open Surgical versus Minimal Invasive Necrosectomy of the Pancreas-A Retrospective Multicenter Analysis of the German Pancreatitis Study Group.Sebastian RaschVeit PhillipStephanie ReichelBettina RauChristian ZapfJonas RosendahlUlrich HalmMarkus ZachäusMartin MüllerAlexander KlegerAlbrecht NeesseJochen HampeMark EllrichmannFelix RückertPeter StraußAlexander ArltVolker EllenriederThomas M GressWerner HartwigErnst KlarJoachim MössnerStefan PostRoland M SchmidThomas SeufferleinMarco SiechJens WernerUwe WillHana AlgülNecrotising 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.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.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.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.http://europepmc.org/articles/PMC5036800?pdf=render |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Sebastian Rasch Veit Phillip Stephanie Reichel Bettina Rau Christian Zapf Jonas Rosendahl Ulrich Halm Markus Zachäus Martin Müller Alexander Kleger Albrecht Neesse Jochen Hampe Mark Ellrichmann Felix Rückert Peter Strauß Alexander Arlt Volker Ellenrieder Thomas M Gress Werner Hartwig Ernst Klar Joachim Mössner Stefan Post Roland M Schmid Thomas Seufferlein Marco Siech Jens Werner Uwe Will Hana Algül |
spellingShingle |
Sebastian Rasch Veit Phillip Stephanie Reichel Bettina Rau Christian Zapf Jonas Rosendahl Ulrich Halm Markus Zachäus Martin Müller Alexander Kleger Albrecht Neesse Jochen Hampe Mark Ellrichmann Felix Rückert Peter Strauß Alexander Arlt Volker Ellenrieder Thomas M Gress Werner Hartwig Ernst Klar Joachim Mössner Stefan Post Roland M Schmid Thomas Seufferlein Marco Siech Jens Werner Uwe Will Hana Algül Open Surgical versus Minimal Invasive Necrosectomy of the Pancreas-A Retrospective Multicenter Analysis of the German Pancreatitis Study Group. PLoS ONE |
author_facet |
Sebastian Rasch Veit Phillip Stephanie Reichel Bettina Rau Christian Zapf Jonas Rosendahl Ulrich Halm Markus Zachäus Martin Müller Alexander Kleger Albrecht Neesse Jochen Hampe Mark Ellrichmann Felix Rückert Peter Strauß Alexander Arlt Volker Ellenrieder Thomas M Gress Werner Hartwig Ernst Klar Joachim Mössner Stefan Post Roland M Schmid Thomas Seufferlein Marco Siech Jens Werner Uwe Will Hana Algül |
author_sort |
Sebastian Rasch |
title |
Open Surgical versus Minimal Invasive Necrosectomy of the Pancreas-A Retrospective Multicenter Analysis of the German Pancreatitis Study Group. |
title_short |
Open Surgical versus Minimal Invasive Necrosectomy of the Pancreas-A Retrospective Multicenter Analysis of the German Pancreatitis Study Group. |
title_full |
Open Surgical versus Minimal Invasive Necrosectomy of the Pancreas-A Retrospective Multicenter Analysis of the German Pancreatitis Study Group. |
title_fullStr |
Open Surgical versus Minimal Invasive Necrosectomy of the Pancreas-A Retrospective Multicenter Analysis of the German Pancreatitis Study Group. |
title_full_unstemmed |
Open Surgical versus Minimal Invasive Necrosectomy of the Pancreas-A Retrospective Multicenter Analysis of the German Pancreatitis Study Group. |
title_sort |
open surgical versus minimal invasive necrosectomy of the pancreas-a retrospective multicenter analysis of the german pancreatitis study group. |
publisher |
Public Library of Science (PLoS) |
series |
PLoS ONE |
issn |
1932-6203 |
publishDate |
2016-01-01 |
description |
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.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.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.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. |
url |
http://europepmc.org/articles/PMC5036800?pdf=render |
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