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(11): 1372-1389 [PMID: 34950427 DOI: 10.4240/wjgs.v13.i11.1372]
Corresponding Author of This Article
Fei Li, MD, PhD, Chief Doctor, Deputy Director, Surgeon, Department of General Surgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing 100053, China. feili36@ccmu.edu.cn
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Control Study
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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(11): 1372-1389 [PMID: 34950427 DOI: 10.4240/wjgs.v13.i11.1372]
Zhi Zheng, Jiong-Di Lu, Yi-Xuan Ding, Yu-Lin Guo, Wen-Tong Mei, Yuan-Xu Qu, Feng Cao, Fei Li, Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
Author contributions: Zheng Z, Lu JD and Ding YX carried out the studies, participated in collecting data; Zheng Z drafted the manuscript; Guo YL, Mei WT and Qu YX performed the statistical analysis and participated in its design; Cao F and Li F participated in acquisition, analysis, or interpretation of data and revised the manuscript; all authors read and approved the final manuscript.
Supported byBeijing Municipal Science and Technology Commission, Capital Research and Demonstration Application of Clinical Diagnosis and Treatment Technology, No. Z191100006619038 and No. Z171100001017077; and Capital Health Research and Development of Special, No. 2020-1-2012.
Institutional review board statement: This study was approved by the Ethics Committee of Xuan Wu Hospital, Capital Medical University, No. 2020-158.
Informed consent statement: Since this was a retrospective study and only analyzed the clinical data of the patients, the need for informed consent was waived. All patient data were analyzed after anonymization.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Corresponding author: Fei Li, MD, PhD, Chief Doctor, Deputy Director, Surgeon, Department of General Surgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing 100053, China. feili36@ccmu.edu.cn
Received: July 29, 2021 Peer-review started: July 29, 2021 First decision: October 3, 2021 Revised: October 6, 2021 Accepted: October 27, 2021 Article in press: October 27, 2021 Published online: November 27, 2021 Processing time: 120 Days and 11 Hours
ARTICLE HIGHLIGHTS
Research background
Although the “Step-up” strategy is the primary surgical treatment for infected pancreatic necrosis, it is not suitable for all infected pancreatic necrosis patients.
Research motivation
The “One-step” strategy represents a novel treatment; however, there is a lack of safety, efficacy, and long-term follow-up clinical data compared with the “Step-up” approach.
Research objectives
This study aimed to compare the safety, efficacy, and long-term follow-up of two surgical approaches.
Research methods
Patients were retrospectively assessed, with a composite endpoint of severe complications or death as the primary outcome. t-test, chi-square test or Fisher’s exact test, and Kaplan-Meier curves were used for further analysis.
Research results
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, there were no significant differences in other observation indicators.
Research conclusions
The “One-step” approach is a safe and effective treatment method with better long-term quality of life and prognosis.
Research perspectives
The “One-step” approach provides an alternative surgical treatment strategy for patients with infected pancreatic necrosis.
