TY - JOUR
T1 - Minimally invasive and endoscopic versus open necrosectomy for necrotising pancreatitis
T2 - A pooled analysis of individual data for 1980 patients
AU - Van Brunschot, Sandra
AU - Hollemans, Robbert A.
AU - Bakker, Olaf J.
AU - Besselink, Marc G.
AU - Baron, Todd H.
AU - Beger, Hans G.
AU - Boermeester, Marja A.
AU - Bollen, Thomas L.
AU - Bruno, Marco J.
AU - Carter, Ross
AU - French, Jeremy J.
AU - Coelho, Djalma
AU - Dahl, Björn
AU - Dijkgraaf, Marcel G.
AU - Doctor, Nilesh
AU - Fagenholz, Peter J.
AU - Farkas, Gyula
AU - Castillo, Carlos Fernandez Del
AU - Fockens, Paul
AU - Freeman, Martin L.
AU - Gardner, Timothy B.
AU - Goor, Harry Van
AU - Gooszen, Hein G.
AU - Hannink, Gerjon
AU - Lochan, Rajiv
AU - McKay, Colin J.
AU - Neoptolemos, John P.
AU - Oláh, Atilla
AU - Parks, Rowan W.
AU - Peev, Miroslav P.
AU - Raraty, Michael
AU - Rau, Bettina
AU - Rösch, Thomas
AU - Rovers, Maroeska
AU - Seifert, Hans
AU - Siriwardena, Ajith K.
AU - Horvath, Karen D.
AU - Van Santvoort, Hjalmar C.
N1 - Publisher Copyright:
© Article author(s).
PY - 2018/4
Y1 - 2018/4
N2 - Objective Minimally invasive surgical necrosectomy and endoscopic necrosectomy, compared with open necrosectomy, might improve outcomes in necrotising pancreatitis, especially in critically ill patients. Evidence from large comparative studies is lacking. Design We combined original and newly collected data from 15 published and unpublished patient cohorts (51 hospitals; 8 countries) on pancreatic necrosectomy for necrotising pancreatitis. Death rates were compared in patients undergoing open necrosectomy versus minimally invasive surgical or endoscopic necrosectomy. To adjust for confounding and to study effect modification by clinical severity, we performed two types of analyses: logistic multivariable regression and propensity score matching with stratification according to predicted risk of death at baseline (low: <5%; intermediate: ≥5% to <15%; high: ≥15% to <35%; and very high: ≥35%). Results Among 1980 patients with necrotising pancreatitis, 1167 underwent open necrosectomy and 813 underwent minimally invasive surgical (n=467) or endoscopic (n=346) necrosectomy. There was a lower risk of death for minimally invasive surgical necrosectomy (OR, 0.53; 95% CI 0.34 to 0.84; p=0.006) and endoscopic necrosectomy (OR, 0.20; 95% CI 0.06 to 0.63; p=0.006). After propensity score matching with risk stratification, minimally invasive surgical necrosectomy remained associated with a lower risk of death than open necrosectomy in the very high-risk group (42/111 vs 59/111; risk ratio, 0.70; 95% CI 0.52 to 0.95; p=0.02). Endoscopic necrosectomy was associated with a lower risk of death than open necrosectomy in the high-risk group (3/40 vs 12/40; risk ratio, 0.27; 95% CI 0.08 to 0.88; p=0.03) and in the very high-risk group (12/57 vs 28/57; risk ratio, 0.43; 95% CI 0.24 to 0.77; p=0.005). Conclusion In high-risk patients with necrotising pancreatitis, minimally invasive surgical and endoscopic necrosectomy are associated with reduced death rates compared with open necrosectomy.
AB - Objective Minimally invasive surgical necrosectomy and endoscopic necrosectomy, compared with open necrosectomy, might improve outcomes in necrotising pancreatitis, especially in critically ill patients. Evidence from large comparative studies is lacking. Design We combined original and newly collected data from 15 published and unpublished patient cohorts (51 hospitals; 8 countries) on pancreatic necrosectomy for necrotising pancreatitis. Death rates were compared in patients undergoing open necrosectomy versus minimally invasive surgical or endoscopic necrosectomy. To adjust for confounding and to study effect modification by clinical severity, we performed two types of analyses: logistic multivariable regression and propensity score matching with stratification according to predicted risk of death at baseline (low: <5%; intermediate: ≥5% to <15%; high: ≥15% to <35%; and very high: ≥35%). Results Among 1980 patients with necrotising pancreatitis, 1167 underwent open necrosectomy and 813 underwent minimally invasive surgical (n=467) or endoscopic (n=346) necrosectomy. There was a lower risk of death for minimally invasive surgical necrosectomy (OR, 0.53; 95% CI 0.34 to 0.84; p=0.006) and endoscopic necrosectomy (OR, 0.20; 95% CI 0.06 to 0.63; p=0.006). After propensity score matching with risk stratification, minimally invasive surgical necrosectomy remained associated with a lower risk of death than open necrosectomy in the very high-risk group (42/111 vs 59/111; risk ratio, 0.70; 95% CI 0.52 to 0.95; p=0.02). Endoscopic necrosectomy was associated with a lower risk of death than open necrosectomy in the high-risk group (3/40 vs 12/40; risk ratio, 0.27; 95% CI 0.08 to 0.88; p=0.03) and in the very high-risk group (12/57 vs 28/57; risk ratio, 0.43; 95% CI 0.24 to 0.77; p=0.005). Conclusion In high-risk patients with necrotising pancreatitis, minimally invasive surgical and endoscopic necrosectomy are associated with reduced death rates compared with open necrosectomy.
KW - endoscopy
KW - minimally invasive
KW - necrosis
KW - pancreatitis
KW - surgery
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U2 - 10.1136/gutjnl-2016-313341
DO - 10.1136/gutjnl-2016-313341
M3 - Article
C2 - 28774886
AN - SCOPUS:85044836240
SN - 0017-5749
VL - 67
SP - 697
EP - 706
JO - Gut
JF - Gut
IS - 4
ER -