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Zhu S, Ning C, Sun Z, Liu B, Hong X, Lin C, Li J, Shen D, Chen L, Huang G. Minimal access retroperitoneal pancreatic necrosectomy for infected pancreatic necrosis: A single-center of 15 years' experience. Surgery 2025; 183:109392. [PMID: 40334494 DOI: 10.1016/j.surg.2025.109392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2024] [Revised: 03/28/2025] [Accepted: 03/31/2025] [Indexed: 05/09/2025]
Abstract
BACKGROUND Minimal access retroperitoneal pancreatic necrosectomy stands as an effective treatment method for infected pancreatic necrosis. However, its popularity still needs to be improved, and in-depth exploration are needed regarding its indications, complications and efficacy. Therefore, we sought to explore the technical details of minimal access retroperitoneal pancreatic necrosectomy surgery and evaluate its safety and efficacy. METHODS A retrospective analysis was performed in a prospective maintained database of infected pancreatic necrosis between January 2010 and April 2024 at a large Chinese tertiary hospital. RESULTS Of 400 patients with infected pancreatic necrosis, 18.8% (75/400) received only percutaneous catheter drainage, 61.2% (245/400) underwent a minimal-access retroperitoneal pancreatic necrosectomy approach, and 20% (80/400) adopted open pancreatic necrosectomy. The number of patients with infected pancreatic necrosis treated with the minimal access retroperitoneal pancreatic necrosectomy procedure has steadily increased over the past decade, accompanied by a decreasing trend in both the mortality and a composite of major complications or death. Minimal access retroperitoneal pancreatic necrosectomy was associated with a lower incidence of gastrointestinal fistula (33 [13.5%] vs 24 [30%], P < .001), mortality (44 [18%] vs 30 [37.5%], P < .001), and composite of major complications or death (88 [35.9%] vs 46 [57.5%], P < .001) compared with open pancreatic necrosectomy. In total, 6.9% (17/245) of patients in the minimal access retroperitoneal pancreatic necrosectomy group required conversion to open pancreatic necrosectomy due to uncontrolled infection or severe complications, whereas 30% (24/80) of patients in the open pancreatic necrosectomy group needed subsequent minimal access retroperitoneal pancreatic necrosectomy to remove residual necrotic tissue and address evolving necrosis. Multivariate analysis of risk factors of conversion to open pancreatic necrosectomy or death indicated that critical acute pancreatitis (odds ratio, 6.1; 95% confidence interval, 1.8-20.7, P = .004), multiple organ failure (odds ratio, 39.7; 95% confidence interval, 4.1-380.6, P < .001), bloodstream infection (odds ratio, 1.1; 95% confidence interval, 1.1-2.8, P = .007), and hemorrhage (odds ratio, 45; 95% confidence interval, 4.4-457.5, P = .004) were significant factors. CONCLUSION Minimal access retroperitoneal pancreatic necrosectomy is a safe and effective approach for improving the prognosis of patients with infected pancreatic necrosis. Standardized surgical procedures, meticulous technical execution, and individualized management are essential for optimizing the efficacy of minimal access retroperitoneal pancreatic necrosectomy.
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Affiliation(s)
- Shuai Zhu
- Department of Pancreatic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; Department of Hernia and Abdominal Wall Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Caihong Ning
- Department of Pancreatic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; Department of Hernia and Abdominal Wall Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; FuRong Laboratory, Changsha, Hunan Province, China
| | - Zefang Sun
- Department of Pancreatic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; Department of Hernia and Abdominal Wall Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Baiqi Liu
- Department of Pancreatic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; Department of Hernia and Abdominal Wall Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Xiaoyue Hong
- Department of Pancreatic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; Department of Hernia and Abdominal Wall Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Chiayan Lin
- Department of Pancreatic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; Department of Hernia and Abdominal Wall Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Jiarong Li
- Department of Pancreatic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; Department of Hernia and Abdominal Wall Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Dingcheng Shen
- Department of Pancreatic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; Department of Hernia and Abdominal Wall Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Lu Chen
- Department of Pancreatic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; Department of Hernia and Abdominal Wall Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Gengwen Huang
- Department of Pancreatic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; Department of Hernia and Abdominal Wall Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; FuRong Laboratory, Changsha, Hunan Province, China.
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Bai R, Sui Y, Lu T, Chen H, Wang G, Kong R, Tan H, Wang Y, Li G, Sun B. Effect of the Step-Jump Approach in Infected Pancreatic Necrosis: A Propensity Score-Matched Study. J Inflamm Res 2024; 17:6005-6021. [PMID: 39253564 PMCID: PMC11382799 DOI: 10.2147/jir.s461740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 07/10/2024] [Indexed: 09/11/2024] Open
Abstract
Purpose The effects of the step-jump approach on the survival and prognosis of infected pancreatic necrosis (IPN) patients have not yet been determined. Patients and Methods Between November 2018 and June 2023, 188 patients were included in this study. There were 144 patients in the step-up group (the SU group) and 44 in the step-jump group (the SJ group). In the SU group, patients successfully treated with percutaneous catheter drainage (PCD) alone were classified into the SU-1 group (n=101), while those requiring additional surgery after PCD were categorized into the SU-2 group (n=43). In the SJ group, patients who underwent minimally invasive necrosectomy (MIN) without PCD were assigned to the SJ-1 group (n=34), whereas those who initially underwent PCD followed by immediate open surgery were placed in the SJ-2 group (n=10). Propensity score matching (PSM) was used to mitigate bias. Results After PSM, a total of 34 pairs were successfully matched. A comparison of the SU group with the SJ-1 group (upfront MIN without PCD) revealed similar mortality rates (P=0.239); however, the incidences of multiple drug-resistant organisms (MDROs) (P=0.029) and surgical complications (P<0.001) were significantly lower in the SJ-1 group. After comparing the SU-2 and SJ-2 groups (patients who underwent direct open necrosectomy without MIN after PCD failure), the incidences of surgical complications and MDRO in the SJ-2 group were significantly lower (P<0.05). Conclusion Compared with the step-up approach, the step-jump approach is safer and more effective and can significantly reduce the incidence of MDRO and surgical complications.
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Affiliation(s)
- Rui Bai
- Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, People's Republic of China
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, People's Republic of China
| | - Yuhang Sui
- Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, People's Republic of China
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, People's Republic of China
| | - Tianqi Lu
- Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, People's Republic of China
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, People's Republic of China
| | - Hua Chen
- Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, People's Republic of China
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, People's Republic of China
| | - Gang Wang
- Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, People's Republic of China
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, People's Republic of China
| | - Rui Kong
- Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, People's Republic of China
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, People's Republic of China
| | - Hongtao Tan
- Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, People's Republic of China
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, People's Republic of China
| | - Yongwei Wang
- Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, People's Republic of China
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, People's Republic of China
| | - Guanqun Li
- Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, People's Republic of China
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, People's Republic of China
| | - Bei Sun
- Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, People's Republic of China
- Key Laboratory of Hepatosplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, People's Republic of China
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Pavlek G, Romic I, Kekez D, Zedelj J, Bubalo T, Petrovic I, Deban O, Baotic T, Separovic I, Strajher IM, Bicanic K, Pavlek AE, Silic V, Tolic G, Silovski H. Step-Up versus Open Approach in the Treatment of Acute Necrotizing Pancreatitis: A Case-Matched Analysis of Clinical Outcomes and Long-Term Pancreatic Sufficiency. J Clin Med 2024; 13:3766. [PMID: 38999333 PMCID: PMC11242895 DOI: 10.3390/jcm13133766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 06/18/2024] [Accepted: 06/19/2024] [Indexed: 07/14/2024] Open
Abstract
Background/Objectives: Acute necrotizing pancreatitis (ANP) with secondary infection of necrotic tissue is associated with a high rate of complications and mortality. The optimal approach is still debatable, but the minimally invasive modality has gained great attention in the last decade as it follows the principle of applying minimal surgical trauma to achieve a satisfying therapeutic objective. We compared clinical outcomes between the step-up approach (SUA) and open necrosectomy (ON) in the treatment of acute necrotizing pancreatitis. Methods: A prospective cohort study over the period of 2011-2021 in a university teaching hospital was performed. Results of 99 consecutive patients with ANP who required surgical/radiological intervention were collected. A case match analysis (2:1) was performed, and the final groups comprised 40 patients in the OA group and 20 patients in the SUA group. Demographic, clinicopathologic, and treatment data were reviewed. Results: Baseline characteristics and disease severity were comparable between the two groups. The patients from the SUA group had a significantly lower morbidity rate and rate of pancreatic insufficiency. Death occurred in 4 of 20 patients (20%) in the SUA group and in 11 of 40 patients (27.5%) in the ON group (risk ratio with the step-up approach, 0.72; 95% confidence interval, 0.26 to 1.99; p = 0.53). Conclusions: A minimally invasive step-up approach provides comparable outcomes to open necrosectomy in the treatment of ANP with infected pancreatic necrosis. While mortality and hospital stay were comparable between the groups, morbidity and pancreatic insufficiency were significantly lower in the SUA group. Further studies on a larger number of patients are required to define the place of SUA in the modern treatment of ANP.
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Affiliation(s)
- Goran Pavlek
- Department of Surgery, University Hospital Centre Zagreb, 10000 Zagreb, Croatia; (G.P.); (J.Z.); (T.B.); (I.P.)
| | - Ivan Romic
- Department of Surgery, University Hospital Centre Zagreb, 10000 Zagreb, Croatia; (G.P.); (J.Z.); (T.B.); (I.P.)
| | - Domina Kekez
- Department of Oncology, University Hospital Centre Zagreb, 10000 Zagreb, Croatia;
| | - Jurica Zedelj
- Department of Surgery, University Hospital Centre Zagreb, 10000 Zagreb, Croatia; (G.P.); (J.Z.); (T.B.); (I.P.)
| | - Tomislav Bubalo
- Department of Surgery, University Hospital Centre Zagreb, 10000 Zagreb, Croatia; (G.P.); (J.Z.); (T.B.); (I.P.)
| | - Igor Petrovic
- Department of Surgery, University Hospital Centre Zagreb, 10000 Zagreb, Croatia; (G.P.); (J.Z.); (T.B.); (I.P.)
| | - Ognjan Deban
- Department of Surgery, University Hospital Centre Zagreb, 10000 Zagreb, Croatia; (G.P.); (J.Z.); (T.B.); (I.P.)
| | - Tomislav Baotic
- Department of Surgery, University Hospital Centre Zagreb, 10000 Zagreb, Croatia; (G.P.); (J.Z.); (T.B.); (I.P.)
| | - Ivan Separovic
- Department of Surgery, University Hospital Centre Zagreb, 10000 Zagreb, Croatia; (G.P.); (J.Z.); (T.B.); (I.P.)
| | - Iva Martina Strajher
- Department of Surgery, University Hospital Centre Zagreb, 10000 Zagreb, Croatia; (G.P.); (J.Z.); (T.B.); (I.P.)
| | - Kristina Bicanic
- Department of Surgery, University Hospital Centre Zagreb, 10000 Zagreb, Croatia; (G.P.); (J.Z.); (T.B.); (I.P.)
| | | | - Vanja Silic
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Gaja Tolic
- Department of Surgery, University Hospital Centre Zagreb, 10000 Zagreb, Croatia; (G.P.); (J.Z.); (T.B.); (I.P.)
| | - Hrvoje Silovski
- Department of Surgery, University Hospital Centre Zagreb, 10000 Zagreb, Croatia; (G.P.); (J.Z.); (T.B.); (I.P.)
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Ning C, Sun Z, Shen D, Lin C, Li J, Wei Q, Chen L, Huang G. Is Contemporary Open Pancreatic Necrosectomy Still Useful In The Minimally Invasive Era? Surgery 2024; 175:1394-1401. [PMID: 38378349 DOI: 10.1016/j.surg.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 10/19/2023] [Accepted: 01/18/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Previous studies have shown that open pancreatic necrosectomy for infected pancreatic necrosis was associated with high morbidity and mortality. However, these results were mostly concluded from historical cohorts with traditional early necrosectomy in the absence of a minimally invasive step-up approach. OBJECTIVE To explore the value of contemporary open pancreatic necrosectomy for infected pancreatic necrosis in the minimally invasive era. METHODS A post hoc analysis was performed in a prospective maintained database of 320 patients with infected pancreatic necrosis from January 2011 to December 2022 at a large Chinese tertiary hospital. RESULTS A total of 320 patients with infected pancreatic necrosis received either a minimally invasive step-up approach (245, 76.6%) or open pancreatic necrosectomy (75, 23.4%), which included upfront open pancreatic necrosectomy (32, 10.0%) and salvage open pancreatic necrosectomy (43, 13.4%). Upfront open pancreatic necrosectomy was associated with similar morbidity and mortality rates but fewer surgical interventions compared with a minimally invasive step-up approach. However, salvage open pancreatic necrosectomy was associated with significantly higher mortality (48.8% vs 18.8%, P = .007), gastrointestinal fistula (44.2% vs 18.8%, P = .021), hemorrhage (48.8% vs 15.6%, P = .003), and intensive care unit stay (25 vs 7 days, P = .040) compared with upfront open pancreatic necrosectomy. Multivariate analysis suggested that multiple organ failure (hazard ratio = 5.1; 95% confidence interval, 1.4-18.2, P = .013) and synchronous critical acute pancreatitis (hazard ratio = 3.0; 95% confidence interval, 1.1-8.6, P = .040) were 2 independent risk factors of death for patients who received open pancreatic necrosectomy. CONCLUSION Patients undergoing upfront open pancreatic necrosectomy received fewer surgical interventions with comparable efficacy compared to the minimally invasive step-up approach. Salvage open pancreatic necrosectomy was potentially lifesaving, though it carried high morbidity and mortality. Multiple organ failure and synchronous critical acute pancreatitis were 2 independent risk factors of death for patients who received open pancreatic necrosectomy.
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Affiliation(s)
- Caihong Ning
- Department of Pancreatic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; Department of Hernia and Abdominal Wall Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Zefang Sun
- Department of Pancreatic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; Department of Hernia and Abdominal Wall Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Dingcheng Shen
- Department of Pancreatic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; Department of Hernia and Abdominal Wall Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Chiayen Lin
- Department of Pancreatic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; Department of Hernia and Abdominal Wall Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Jiarong Li
- Department of Pancreatic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; Department of Hernia and Abdominal Wall Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Qin Wei
- Department of Pancreatic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; Department of Hernia and Abdominal Wall Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Lu Chen
- Department of Pancreatic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; Department of Hernia and Abdominal Wall Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Gengwen Huang
- Department of Pancreatic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; Department of Hernia and Abdominal Wall Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan Province, China.
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Yang Y, Liu Y, Liu Z, Peng T, Wang C, Wu H, Gou S. Laparoscopic necrosectomy for acute necrotizing pancreatitis: mesocolon-preserving approach and outcomes. Updates Surg 2024; 76:487-493. [PMID: 38429596 DOI: 10.1007/s13304-024-01773-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/29/2024] [Indexed: 03/03/2024]
Abstract
The surgical treatment of acute necrotizing pancreatitis has significantly evolved in recent years with the advent of enhanced imaging techniques and minimally invasive surgery. Various minimally invasive techniques, such as video-assisted retroperitoneal debridement (VARD) and endoscopic transmural necrosectomy (ETN), have been employed in the management of acute necrotizing pancreatitis and are often part of step-up approaches. However, almost all reported step-up approaches only employ a fixed minimally invasive technique prior to open surgery. In contrast, we implemented different minimally invasive techniques during the treatment of acute pancreatitis based on the extent of pancreatic necrosis. For acute necrotizing pancreatitis of the pancreatic bed with or without extension into the left retroperitoneum, we performed mesocolon-preserving laparoscopic necrosectomy for debridment. The quantitative indication for pancreatic debridment in our institute has been described previously. For acute necrotizing pancreatitis of the pancreatic bed with or without extension into the left retroperitoneum, mesocolon-preserving laparoscopic necrosectomy was performed for debridment. To safeguard the mesocolon, the pancreatic bed was entered via the gastrocolic ligament, and the left retroperitoneum was accessed via the lateral peritoneal attachments of the descending colon. Of the 77 patients requiring pancreatic debridment, 41 patients were deemed suitable for mesocolon-preserving laparoscopic necrosectomy by multiple disciplinary team and informed consent was acquired. Of these 41 patients, 27 underwent percutaneous drainage, 10 underwent transluminal drainage, and 2 underwent transluminal necrosectomy prior to laparoscopic necrosectomy. Two patients (4.88%) died of sepsis, three patients (7.32%) required further laparotomic necrosectomy, and five patients (12.20%) required additional percutaneous drainage for residual infection. Three patients (7.32%) experienced duodenal fistula, all of which were cured through non-surgical treatments. Nineteen patients (46.34%) developed pancreatic fistula that persisted for over 3 weeks, with 17 being successfully treated non-surgically. The remaining two patients had pancreatic fistulas that lasted over 3 months; an internal drainage procedure has been planned for them. No patient developed colonic fistula. Mesocolon-preserving laparoscopic necrosectomy proved to be safe and effective in selected patients. It can serve as a supplementary procedure for step-up approaches or as an alternative to other debridment procedures such as VARD, ETN, and laparotomic necrosectomy.
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Affiliation(s)
- Yuxin Yang
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jifang Avenue, Wuhan, 430022, China
- Sino-German Laboratory of Personalized Medicine for Pancreatic Cancer, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yang Liu
- Sino-German Laboratory of Personalized Medicine for Pancreatic Cancer, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhiqiang Liu
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jifang Avenue, Wuhan, 430022, China
- Sino-German Laboratory of Personalized Medicine for Pancreatic Cancer, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tao Peng
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jifang Avenue, Wuhan, 430022, China
- Sino-German Laboratory of Personalized Medicine for Pancreatic Cancer, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chunyou Wang
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jifang Avenue, Wuhan, 430022, China
- Sino-German Laboratory of Personalized Medicine for Pancreatic Cancer, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Heshui Wu
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jifang Avenue, Wuhan, 430022, China
- Sino-German Laboratory of Personalized Medicine for Pancreatic Cancer, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shanmiao Gou
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jifang Avenue, Wuhan, 430022, China.
- Sino-German Laboratory of Personalized Medicine for Pancreatic Cancer, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Lu J, Zheng Z, Ding Y, Qu Y, Mei W, Fang Z, Qu C, Feng Y, Guo Y, Gao C, Cao F, Li F. Characteristics and Incidence of Colon Complication in Necrotizing pancreatitis: A Propensity Score-Matched Study. J Inflamm Res 2023; 16:127-144. [PMID: 36660375 PMCID: PMC9843501 DOI: 10.2147/jir.s388305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/24/2022] [Indexed: 01/11/2023] Open
Abstract
Objective To clarify the incidence of colonic complications in patients with NP and their impact on prognosis. Methods The clinical data of NP patients admitted to the Department of General Surgery of Xuanwu Hospital, Capital Medical University from January 2014 to December 2020 were retrospectively analyzed. Patients were grouped according to the presence or absence of colonic complications, and the clinical prognosis of the two groups was analyzed after matching using a 1:1 propensity score, The primary study endpoint was patient mortality during hospitalization. Data are reported as median (range) or percentage of patients (%). Results A total of 306 patients with NP were included in this study, and the incidence of colonic complications was 12.4%, including 15 cases of colonic obstruction, 17 cases of colonic fistula, and 9 cases of colonic hemorrhage. Before matching, patients in the colonic group had severe admissions and poor clinical outcomes (P<0.05). After matching, the baseline data and clinical characteristics at admission were comparable between the two groups of patients. In terms of clinical outcomes, although the mortality was similar in the two groups (P>0.05), but patients in the colonic group were more likely to have multiorgan failure, length of nutrition support, number of minimally invasive interventions, number of extra-pancreatic infections, length of ICU stay and total length of stay were significantly higher than those of patients in the group without colonic complications (P<0.05). During long-term follow-up, patients in the colonic group were more likely to develop recurrent pancreatitis. Conclusion About 12.4% of NP patients developed colonic complications, and after PSM it was found that colonic complications only led to a longer hospital stay and an increased number of clinical interventions in NP patients and did not increase the mortality.
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Affiliation(s)
- Jiongdi Lu
- Clinical Center of Acute Pancreatitis, Capital Medical University, Beijing, People’s Republic of China,Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Zhi Zheng
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yixuan Ding
- Clinical Center of Acute Pancreatitis, Capital Medical University, Beijing, People’s Republic of China,Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yuanxu Qu
- Clinical Center of Acute Pancreatitis, Capital Medical University, Beijing, People’s Republic of China,Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Wentong Mei
- Clinical Center of Acute Pancreatitis, Capital Medical University, Beijing, People’s Republic of China,Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Zhen Fang
- Clinical Center of Acute Pancreatitis, Capital Medical University, Beijing, People’s Republic of China,Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Chang Qu
- Clinical Center of Acute Pancreatitis, Capital Medical University, Beijing, People’s Republic of China,Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yulu Feng
- Chui Yang Liu Hospital Affiliated Tsinghua University, Beijing, People’s Republic of China
| | - Yulin Guo
- Clinical Center of Acute Pancreatitis, Capital Medical University, Beijing, People’s Republic of China,Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Chongchong Gao
- Clinical Center of Acute Pancreatitis, Capital Medical University, Beijing, People’s Republic of China,Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Feng Cao
- Clinical Center of Acute Pancreatitis, Capital Medical University, Beijing, People’s Republic of China,Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China,Feng Cao, Clinical Center of Acute Pancreatitis, Department of General Surgery, Xuanwu Hospital of Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing, 100053, People’s Republic of China, Email
| | - Fei Li
- Clinical Center of Acute Pancreatitis, Capital Medical University, Beijing, People’s Republic of China,Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China,Correspondence: Fei Li, Clinical Center of Acute Pancreatitis, Department of General Surgery, Department of Surgery, Xuanwu Hospital of Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing, 100053, People’s Republic of China, Tel +86-10-83198731, Fax +86-10-83198868, Email
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Guo Y, Wang X, Wang S, Li A, Cao F, Li F. Predictive Risk Factors of Pancreatic Exocrine Insufficiency Developed After Acute Pancreatitis: A Retrospective Cohort Study. J Inflamm Res 2023; 16:1157-1167. [PMID: 36950051 PMCID: PMC10025014 DOI: 10.2147/jir.s392932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/25/2023] [Indexed: 03/17/2023] Open
Abstract
Purpose The aim of this study was to compare the clinical characteristics of acute pancreatitis (AP) patients between those who developed pancreatic exocrine insufficiency (PEI) and those who did not, and to investigate the predictive factors of PEI. Patients and Methods From October 1st 2019 to July 30th 2021, AP patients admitted at our center were included. The fecal elastase-1 assay was adopted for PEI diagnosis. The clinical characteristics, treatments, and outcomes between the patients with and without PEI were analyzed. Results In total, 63 males and 42 females were included. There were 27 patients with mild AP, 54 with moderately severe AP, and 24 with severe AP. The median modified computed tomography severity index (MCTSI) was 6.000(4.000, 8.000). During the follow-up, 38 patients developed PEI after AP. The univariate analysis showed that higher ASA grade (P = 0.006), more severe AP (P = 0.000), the presence of multiple organ dysfunction syndrome (P = 0.030), higher MCTSI (P = 0.000), the development of infected pancreatic necrosis (P = 0.002) and local complications (P = 0.000), higher levels of triacylglycerol (P = 0.022), video-assisted retroperitoneal debridement intervention (P = 0.015), and longer intensive care unit stay (P = 0.044) were correlated with PEI development. Furthermore, the logistic regression analyses showed that MCTSI during hospitalization is an independent risk factor for PEI development during the AP recovery period. Conclusion ASA grade, severity of AP, multiple organ dysfunction syndrome, MCTSI, infected pancreatic necrosis, local complications, higher levels of triacylglycerol, video-assisted retroperitoneal debridement intervention, and longer intensive care unit stay were potentially associated with PEI development during the AP recovery period. High MCTSI was independently associated with the development of PEI during the AP recovery period, which may help alert to the possibility of PEI to help with its early detection and treatment.
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Affiliation(s)
- Yulin Guo
- Department of General Surgery, Xuanwu Hospital of Capital Medical University, Beijing, People’s Republic of China
- Acute Pancreatitis Clinical Center of Capital Medical University, Beijing, People’s Republic of China
| | - Xiaohui Wang
- Department of General Surgery, Xuanwu Hospital of Capital Medical University, Beijing, People’s Republic of China
- Acute Pancreatitis Clinical Center of Capital Medical University, Beijing, People’s Republic of China
| | - Shuo Wang
- Department of General Surgery, Xuanwu Hospital of Capital Medical University, Beijing, People’s Republic of China
- Acute Pancreatitis Clinical Center of Capital Medical University, Beijing, People’s Republic of China
| | - Ang Li
- Department of General Surgery, Xuanwu Hospital of Capital Medical University, Beijing, People’s Republic of China
- Acute Pancreatitis Clinical Center of Capital Medical University, Beijing, People’s Republic of China
| | - Feng Cao
- Department of General Surgery, Xuanwu Hospital of Capital Medical University, Beijing, People’s Republic of China
- Acute Pancreatitis Clinical Center of Capital Medical University, Beijing, People’s Republic of China
| | - Fei Li
- Department of General Surgery, Xuanwu Hospital of Capital Medical University, Beijing, People’s Republic of China
- Acute Pancreatitis Clinical Center of Capital Medical University, Beijing, People’s Republic of China
- Correspondence: Fei Li; Feng Cao, Department of General Surgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing, 100053, People’s Republic of China, Tel/Fax +86-10-83198835, Email ;
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Lu J, Ding Y, Qu Y, Mei W, Guo Y, Fang Z, Qu C, Gao C, Cao F, Li F, Feng Y. Risk Factors and Outcomes of Multidrug-Resistant Bacteria Infection in Infected Pancreatic Necrosis Patients. Infect Drug Resist 2022; 15:7095-7106. [PMID: 36483142 PMCID: PMC9725918 DOI: 10.2147/idr.s387384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 11/18/2022] [Indexed: 08/30/2023] Open
Abstract
OBJECTIVE The incidence of acute pancreatitis (AP) is increasing. Twenty percent of AP patients with developing necrotizing pancreatitis (NP), while ~40-70% of NP patients develop potentially fatal infectious complications. When patients are suspected or confirmed infected pancreatic necrosis (IPN), antibiotics should be administered timeously to control the infection, but long-term use of antibiotics can lead to multidrug-resistant bacteria (MDRB) infection and eventually to increased mortality. Our study aimed to determine the incidence of MDRB infection and evaluate the risk factors for MDRB infection in IPN patients. METHODS Clinical data of IPN patients admitted to the general surgery department of Xuanwu Hospital of Capital Medical University between January 1, 2014, and December 31, 2021, were retrospectively analyzed. RESULTS IPN patients (n = 267) were assigned to MDRB infection (n = 124) and non-MDRB infection (n = 143) groups. On admission, patients in the MDRB group had a higher modified computer tomography severity index (CTSI) score (P < 0.05), pancreatic necrosis degree, and PCT level (P < 0.05) than those in the non-MDRB group, and the prognosis of patients in MDRB group was poor. The most common gram-negative bacteria were Acinetobacter baumannii (n = 117), the most common gram-positive bacteria were Enterococcus faecium (n = 98), and the most common fungal infection was Candida albicans (n = 47). Multivariable analysis showed that complications of EPI (OR: 4.116, 95% CI: 1.381-12.271, P = 0.011), procalcitonin (PCT) level at admission (OR: 2.728, 95% CI: 1.502-4.954, P = 0.001), and degree of pancreatic necrosis (OR: 2.741, 95% CI: 1.109-6.775, P = 0.029) were independent risk factors for MDRB infection in IPN patients. CONCLUSION We identified common infectious strains and risk factors for MDRB infection in IPN patients.
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Affiliation(s)
- Jiongdi Lu
- Clinical Center of Acute Pancreatitis, Capital Medical University, Beijing, People’s Republic of China
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yixuan Ding
- Clinical Center of Acute Pancreatitis, Capital Medical University, Beijing, People’s Republic of China
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yuanxu Qu
- Clinical Center of Acute Pancreatitis, Capital Medical University, Beijing, People’s Republic of China
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Wentong Mei
- Clinical Center of Acute Pancreatitis, Capital Medical University, Beijing, People’s Republic of China
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yulin Guo
- Clinical Center of Acute Pancreatitis, Capital Medical University, Beijing, People’s Republic of China
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Zhen Fang
- Clinical Center of Acute Pancreatitis, Capital Medical University, Beijing, People’s Republic of China
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Chang Qu
- Clinical Center of Acute Pancreatitis, Capital Medical University, Beijing, People’s Republic of China
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Chongchong Gao
- Clinical Center of Acute Pancreatitis, Capital Medical University, Beijing, People’s Republic of China
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Feng Cao
- Clinical Center of Acute Pancreatitis, Capital Medical University, Beijing, People’s Republic of China
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Fei Li
- Clinical Center of Acute Pancreatitis, Capital Medical University, Beijing, People’s Republic of China
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yulu Feng
- Department of Pediatric, Chui Yang Liu Hospital Affiliated Tsinghua University, Beijing, People’s Republic of China
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9
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Timing, approach, and treatment strategies for infected pancreatic necrosis: a narrative review. JOURNAL OF PANCREATOLOGY 2022. [DOI: 10.1097/jp9.0000000000000105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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10
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Zheng Z, Lu J, Cao F, Ding Y, Guo Y, Mei W, Qu Y, Liu S, Sun H, Cui Y, Li A, Li F. "One-step" approach versus "Step-up" approach minimally invasive treatment for infected pancreatic necrosis: a study protocol for a single-center, prospective, randomized controlled trial. BMC Gastroenterol 2022; 22:41. [PMID: 35114931 PMCID: PMC8811975 DOI: 10.1186/s12876-022-02116-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 01/22/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Currently, the minimally invasive "Step-up" surgical strategy is still the main treatment for infected pancreatic necrosis (IPN). However, indiscriminate implementation of the "Step-up" strategy can lead to increased numbers of operations and prolonged hospital stay. The "Step-up" approach is not appropriate for some patients due to unavailabilty of a safe puncture path. Therefore, we developed the "One-step" surgical approach to treat IPN, which is safety. However, there is still a lack of comparison of the short and long-term efficacy between the "One-step" and "Step-up" approach. Consequently, we are conducting this clinical trial to provide a reference for IPN treatment. METHODS This is an ongoing, single-center, randomized controlled trial of patients with IPN. The total sample size required for the trial (May 2021-December 2023) is approximately 128 patients. Patients will be randomly assigned to either an experimental group (One-step) or a control group (Step-up) at a ratio of 1:1 using the block randomization method. We used the case report forms and electronic data capture systems to obtain demographic information, preoperative laboratory examination, auxiliary examination results, surgery data, postoperative recovery outcomes, and follow-up outcomes. The patients will be followed up for 2 years after surgery. The primary endpoint is a composite endpoint, consisting of mortality and severe complications. The secondary endpoints include the incidence of organ dysfunction, the number of surgical procedures, mortality (the incidence of death in hospital and deaths within 30 days of discharge), hospital stay, intensive care unit stay, hospitalization costs, perioperative inflammatory marker changes, and short-and long-term complications. DISCUSSION Compared with the "Step-up," the "One-step" minimally invasive surgery can significantly reduce the number of operations, reduce the length of hospital stay and hospitalization costs without increasing the incidence of composite endpoint events, and has better short- and long-term efficacy and safety. Additionally, there was no statistically significant difference in perioperative complications and mortality between "Step-up" and "One-step". This study will assist with the formulation of an effective and scientific "One-step" minimally invasive treatment strategy for IPN, and an understanding of this technique will facilitate clinical decision-making for IPN. Trial Registration ChiCTR2100044348. Trial status: Ongoing.
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Affiliation(s)
- Zhi Zheng
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, No.45 Chang-chun street, Xi-Cheng District, Beijing, 100053, China.,Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, China
| | - Jiongdi Lu
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, No.45 Chang-chun street, Xi-Cheng District, Beijing, 100053, China.,Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, China
| | - Feng Cao
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, No.45 Chang-chun street, Xi-Cheng District, Beijing, 100053, China.,Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, China
| | - Yixuan Ding
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, No.45 Chang-chun street, Xi-Cheng District, Beijing, 100053, China.,Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, China
| | - Yulin Guo
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, No.45 Chang-chun street, Xi-Cheng District, Beijing, 100053, China.,Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, China
| | - Wentong Mei
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, No.45 Chang-chun street, Xi-Cheng District, Beijing, 100053, China.,Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, China
| | - Yuanxu Qu
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, No.45 Chang-chun street, Xi-Cheng District, Beijing, 100053, China.,Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, China
| | - Shuang Liu
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, No.45 Chang-chun street, Xi-Cheng District, Beijing, 100053, China.,Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, China
| | - Haichen Sun
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, No.45 Chang-chun street, Xi-Cheng District, Beijing, 100053, China.,Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, China
| | - Yeqing Cui
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, No.45 Chang-chun street, Xi-Cheng District, Beijing, 100053, China.,Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, China
| | - Ang Li
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, No.45 Chang-chun street, Xi-Cheng District, Beijing, 100053, China.,Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, China
| | - Fei Li
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, No.45 Chang-chun street, Xi-Cheng District, Beijing, 100053, China. .,Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, China.
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11
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Han SB, Chen JH, Hu P, Chen D, Chen QY, Zheng H, Xu P, Wang CY, Zhao G. One-step laparoscopic pancreatic necrosectomy verse surgical step-up approach for infected pancreatic necrosis: a case-control study. World J Emerg Med 2022; 13:274-282. [PMID: 35837558 PMCID: PMC9233970 DOI: 10.5847/wjem.j.1920-8642.2022.058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/21/2022] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND The surgical step-up approach often requires multiple debridements and might not be suitable for infected pancreatic necrosis (IPN) patients with various abscesses or no safe route for percutaneous catheter drainage (PCD). This case-control study aimed to investigate the safety and effectiveness of one-step laparoscopic pancreatic necrosectomy (LPN) in treating IPN. METHODS This case-control study included IPN patients undergoing one-step LPN or surgical step-up in our center from January 2015 to December 2020. The short-term and long-term complications after surgery, length of hospital stay, and postoperative ICU stays in both groups were analyzed. Univariate and multivariate logistic regression analyses were performed to explore the risk factors of major complications or death. RESULTS A total of 53 IPN patients underwent one-step LPN and 37 IPN patients underwent surgical step-up approach in this study. There was no significant difference in the incidence of death, major complications, new-onset diabetes, or new-onset pancreatic exocrine insufficiency between the two groups. However, the length of hospital stay in the one-step LPN group was significantly shorter than that in the surgical step-up group. Univariate regression analysis showed that the surgical approach (one-step/step-up) was not the risk factor for major complications or death. Multivariate logistic regression analysis indicated that computed tomography (CT) severity index, American Society of Anesthesiologists (ASA) class IV, and white blood cell (WBC) were the significant risk factors for major complications or death. CONCLUSION One-step LPN is as safe and effective as the surgical step-up approach for treating IPN patients, and reduces total hospital stay.
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Affiliation(s)
- Sheng-bo Han
- Department of Emergency Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Jin-huang Chen
- Department of Emergency Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Ping Hu
- Department of Emergency Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Ding Chen
- Department of Emergency Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Qing-yong Chen
- Department of Emergency Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Hai Zheng
- Department of Emergency Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Peng Xu
- Department of Emergency Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Chun-you Wang
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Gang Zhao
- Department of Emergency Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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12
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Zheng Z, Lu JD, Ding YX, Guo YL, Mei WT, Qu YX, Cao F, Li F. Comparison of safety, efficacy, and long-term follow-up between “one-step” and “step-up” approaches for infected pancreatic necrosis. World J Gastrointest Surg 2021; 13:1372-1389. [PMID: 34950427 PMCID: PMC8649571 DOI: 10.4240/wjgs.v13.i11.1372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/06/2021] [Accepted: 10/27/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although the “Step-up” strategy is the primary surgical treatment for infected pancreatic necrosis, it is not suitable for all such patients. The “One-step” strategy represents a novel treatment, but the safety, efficacy, and long-term follow-up have not yet been compared between these two approaches.
AIM To compare the safety, efficacy, and long-term follow-up of two surgical approaches to provide a reference for infected pancreatic necrosis treatment.
METHODS This was a retrospective analysis of infectious pancreatic necrosis patients who underwent “One-step” or “Step-up” necrosectomy at Xuan Wu Hospital, Capital Medical University, from May 2014 to December 2020. The primary outcome was the composite endpoint of severe complications or death. Patients were followed up every 6 mo after discharge until death or June 30, 2021. Statistical analysis was performed using SPSS 21.0 and GraphPad Prism 8.0, and statistical significance was set at P < 0.05.
RESULTS One-hundred-and-fifty-eight patients were enrolled, of whom 61 patients underwent “One-step” necrosectomy and 97 patients underwent “Step-up” necrosectomy. During the long-term follow-up period, 40 patients in the “One-step” group and 63 patients in the “Step-up” group survived. The time from disease onset to hospital admission (53.69 ± 38.14 vs 32.20 ± 20.75, P < 0.001) and to initial surgical treatment was longer in the “Step-up” than in the “One-step” group (54.38 ± 10.46 vs 76.58 ± 17.03, P < 0.001). Patients who underwent “Step-up” necrosectomy had a longer hospitalization duration (65.41 ± 28.14 vs 52.76 ± 24.71, P = 0.02), and more interventions (4.26 ± 1.71 vs 3.18 ± 1.39, P < 0.001). Postoperative inflammatory indicator levels were significantly lower than preoperative levels in each group. Although the incisional hernia incidence was higher in the “One-step” group, no significant difference was found in the composite outcomes of severe complications or death, new-onset organ failure, postoperative complications, inflammatory indicators, long-term complications, quality of life, and medical costs between the groups (P > 0.05).
CONCLUSION Compared with the “Step-up” approach, the “One-step” approach is a safe and effective treatment method with better long-term quality of life and prognosis. It also provides an alternative surgical treatment strategy for patients with infected pancreatic necrosis.
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Affiliation(s)
- Zhi Zheng
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Jiong-Di Lu
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Yi-Xuan Ding
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Yu-Lin Guo
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Wen-Tong Mei
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Yuan-Xu Qu
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Feng Cao
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Fei Li
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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13
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From "step-up" to "step-jump": a leap-forward intervention for infected necrotizing pancreatitis. Chin Med J (Engl) 2021; 135:285-287. [PMID: 34759231 PMCID: PMC8812598 DOI: 10.1097/cm9.0000000000001877] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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14
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Cao F, Li A, Wang X, Gao C, Li J, Li F. Laparoscopic transgastric necrosectomy in treatment of walled-off pancreatic necrosis with sinistral portal hypertension. BMC Surg 2021; 21:362. [PMID: 34629061 PMCID: PMC8502321 DOI: 10.1186/s12893-021-01361-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 09/24/2021] [Indexed: 12/16/2022] Open
Abstract
Background Laparoscopic transgastric necrosectomy (LTGN) has been used in treatment of walled-off pancreatic necrosis (WON) for more than a decade. However, the safety and effectiveness of LTGN for WON with sinistral portal hypertension was still unclear. Methods WON patients with sinistral portal hypertension treated in our department between January 2011 and December 2018 were included and retrospectively analyzed in this study. Patients were divided into two groups according to different surgical approaches, LTNG or laparoscopic assisted trans-lesser sac necrosectomy (LATLSN). Perioperative and long-term outcomes were compared between two groups. Results 312 cases diagnosed with WON were screened and 53 were finally included in this study. Of the included patients, 21 and 32 cases were received LTGN and LATLSN, respectively. LTGN was associated with significantly lower morbidity than LATLSN (19.0% vs 46.9%, p = 0.04) and similar severe complication (Clavien–Dindo ≥ III) rate (12.5% vs 19.0%, p = 0.70). LTGN did not increase the rate of postoperative hemorrhage (9.5% vs 6.3%, p = 1.00) and mortality (9.5% vs 9.4%, p = 1.00). After 39 (11–108) months follow-up, the recurrence rate of WON and long-term complications were also comparable between groups. Conclusion From current data, LTGN was safe and effective in treatment of WON patients with sinistral portal hypertension in terms of short- and long-term outcomes.
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Affiliation(s)
- Feng Cao
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, No. 45, Xicheng, Beijing, 100053, People's Republic of China.,Clinical Center for Acute Pancreatitis, Capital Medical University, No. 45, Xicheng, Beijing, 100053, People's Republic of China
| | - Ang Li
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, No. 45, Xicheng, Beijing, 100053, People's Republic of China.,Clinical Center for Acute Pancreatitis, Capital Medical University, No. 45, Xicheng, Beijing, 100053, People's Republic of China
| | - Xiaohui Wang
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, No. 45, Xicheng, Beijing, 100053, People's Republic of China.,Clinical Center for Acute Pancreatitis, Capital Medical University, No. 45, Xicheng, Beijing, 100053, People's Republic of China
| | - Chongchong Gao
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, No. 45, Xicheng, Beijing, 100053, People's Republic of China.,Clinical Center for Acute Pancreatitis, Capital Medical University, No. 45, Xicheng, Beijing, 100053, People's Republic of China
| | - Jia Li
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, No. 45, Xicheng, Beijing, 100053, People's Republic of China. .,Clinical Center for Acute Pancreatitis, Capital Medical University, No. 45, Xicheng, Beijing, 100053, People's Republic of China.
| | - Fei Li
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, No. 45, Xicheng, Beijing, 100053, People's Republic of China. .,Clinical Center for Acute Pancreatitis, Capital Medical University, No. 45, Xicheng, Beijing, 100053, People's Republic of China.
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15
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Li F, Cai S, Cao F, Chen R, Fu D, Ge C, Hao C, Hao J, Huang H, Jian Z, Jin G, Li A, Li H, Li S, Li W, Li Y, Liang T, Liu X, Lou W, Miao Y, Mou Y, Peng C, Qin R, Shao C, Sun B, Tan G, Tian X, Wang H, Wang L, Wang W, Wang W, Wei J, Wu H, Wu W, Wu Z, Yan C, Yang Y, Yin X, Yu X, Yuan C, Zhang T, Zhao Y. Guidelines for the diagnosis and treatment of acute pancreatitis in China (2021). JOURNAL OF PANCREATOLOGY 2021; 4:67-75. [DOI: 10.1097/jp9.0000000000000071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Abstract
Acute pancreatitis (AP) is a common acute abdominal condition of the digestive system. In recent years, treatment concepts, methods, and strategies for the diagnosis of AP have advanced, and this has played an important role in promoting the standardization of AP diagnosis and treatment and improving the treatment quality of AP patients. On the basis of previous guidelines and expert consensus, this guideline adopts an evidence-based, problem-based expression; synthesizes important clinical research data at home and abroad in the most recent 5 years; and forms 29 recommendations through multidisciplinary expert discussion, including diagnosis, treatment, and follow-up. It is expected to provide evidence support for the treatment of AP in the clinical setting in China.
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Affiliation(s)
- Fei Li
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing
| | - Shouwang Cai
- Department of Hepatobiliary and Pancreatic Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing
| | - Feng Cao
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing
| | - Rufu Chen
- Pancreatic Center, Guangdong Provincial People's Hospital, Guangzhou, Guangdong Province
| | - Deliang Fu
- Department of Pancreatic Surgery, Huashan Hospital, Fudan University, Shanghai
| | - Chunlin Ge
- Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province
| | - Chunyi Hao
- Department of Hepatopancreatobiliary Surgery, Peking University Cancer Hospital, Beijing
| | - Jihui Hao
- Department of Pancreatic Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin
| | - Heguang Huang
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province
| | - Zhixiang Jian
- Department of General Surgery, Guangdong Provincial People's Hospital, Guangzhou, Guangdong Province
| | - Gang Jin
- Department of Hepatobiliary Pancreatic Surgery, Changhai Hospital Affiliated to Navy Medical University, Shanghai
| | - Ang Li
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing
| | - Haimin Li
- Department of Hepatobiliary Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi Province
| | - Shengping Li
- Department of Pancreatobiliary Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong Province
| | - Weiqin Li
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province
| | - Yixiong Li
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province
| | - Tingbo Liang
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital of Medical College, Zhejiang University, Hangzhou, Zhejiang Province
| | - Xubao Liu
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province
| | - Wenhui Lou
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai
| | - Yi Miao
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province
| | - Yiping Mou
- Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang Province
| | - Chenghong Peng
- Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Renyi Qin
- Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province
| | - Chenghao Shao
- Department of Pancreatic-biliary Surgery, Changzheng Hospital, Second Military Medical University, Shanghai
| | - Bei Sun
- Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province
| | - Guang Tan
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province
| | - Xiaodong Tian
- Department of General Surgery, Peking University First Hospital, Beijing
| | - Huaizhi Wang
- Institute of Hepatopancreatobiliary Surgery, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing
| | - Lei Wang
- Department of Pancreatic Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong Province
| | - Wei Wang
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai
| | - Weilin Wang
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province
| | - Junmin Wei
- Department of General Surgery, Beijing Hospital, Beijing
| | - Heshui Wu
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province
| | - Wenming Wu
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing
| | - Zheng Wu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province
| | - Changqing Yan
- Department of Hepatobiiary Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province
| | - Yinmo Yang
- Institute of Hepatopancreatobiliary Surgery, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing
| | - Xiaoyu Yin
- Department of Pancreato-Biliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province
| | - Xianjun Yu
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai
| | - Chunhui Yuan
- Department of General Surgery, Peking University Third Hospital, Beijing, China
| | - Taiping Zhang
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing
| | - Yupei Zhao
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing
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16
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Sgaramella LI, Gurrado A, Pasculli A, Prete FP, Catena F, Testini M. Open necrosectomy is feasible as a last resort in selected cases with infected pancreatic necrosis: a case series and systematic literature review. World J Emerg Surg 2020; 15:44. [PMID: 32727508 PMCID: PMC7391590 DOI: 10.1186/s13017-020-00326-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 07/21/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Acute pancreatitis is a common inflammatory pancreatic disorder, often caused by gallstone disease and frequently requiring hospitalization. In 80% of cases, a rapid and favourable outcome is described, while a necrosis of pancreatic parenchyma or extra-pancreatic tissues is reported in 10-20% of patients. The onset of pancreatic necrosis determines a significant increase of early organ failure rate and death that has higher incidence if infection of pancreatic necrosis (IPN) or extra-pancreatic collections occur. IPN always requires an invasive intervention, and, in the last decade, the advent of minimally invasive techniques has gradually replaced the employment of the open traditional approach. We report a series of three severe cases of IPN managed with primary open necrosectomy (ON) and a systematic review of the literature, in order to understand if emergency surgery still has a role in the current clinical practice. METHODS From January 2010 to January 2020, 3 cases of IPN were treated in our Academic Department of General and Emergency Surgery. We performed a PubMed MEDLINE search on the ON of IPN, selecting 20 from 654 articles for review. RESULTS The 3 cases were male patients with a mean age of 61.3 years. All patients referred to our service complaining an evolving severe clinical condition evocating a sepsis due to IPN. CT scan was the main diagnostic tool. Patients were initially conservatively managed. In consideration of clinical worsening conditions, and at the failure of conservative and minimal invasive treatment, they were, finally, managed with emergency ON. Patients reported no complications nor procedure-related sequelae in the follow-up period. CONCLUSION The ON is confirmed to be the last resort, useful in selected severe cases, with a defined timing and in case of proven non-feasibility and no advantage of other minimally invasive approaches.
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Affiliation(s)
- Lucia Ilaria Sgaramella
- Unit of General Surgery "V. Bonomo", Department of Biomedical Sciences and Human Oncology, University of Bari "A. Moro", Polyclinic of Bari, Piazza Giulio Cesare, 11, 70124, Bari, Italy
| | - Angela Gurrado
- Unit of General Surgery "V. Bonomo", Department of Biomedical Sciences and Human Oncology, University of Bari "A. Moro", Polyclinic of Bari, Piazza Giulio Cesare, 11, 70124, Bari, Italy
| | - Alessandro Pasculli
- Unit of General Surgery "V. Bonomo", Department of Biomedical Sciences and Human Oncology, University of Bari "A. Moro", Polyclinic of Bari, Piazza Giulio Cesare, 11, 70124, Bari, Italy
| | - Francesco Paolo Prete
- Unit of General Surgery "V. Bonomo", Department of Biomedical Sciences and Human Oncology, University of Bari "A. Moro", Polyclinic of Bari, Piazza Giulio Cesare, 11, 70124, Bari, Italy
| | - Fausto Catena
- Department of Emergency and Trauma Surgery, Parma University Hospital, Viale Antonio Gramsci, 14, 43126, Parma, Italy
| | - Mario Testini
- Unit of General Surgery "V. Bonomo", Department of Biomedical Sciences and Human Oncology, University of Bari "A. Moro", Polyclinic of Bari, Piazza Giulio Cesare, 11, 70124, Bari, Italy.
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