Table 4.
Comparison of various techniques for treating pancreatic necrosectomy
| Technique reference | Patient number | Death number | Infected necrosis number* | Pre-op. ITU number | Post-op. ITU number | Comment |
|---|---|---|---|---|---|---|
| Percutaneous drainage | ||||||
|
Drainage only. Van Santvoort HC et al. (2010). |
17 | 2 (11.8%) | PANTER multicenter Dutch trial n = 88 patients with randomized to open necrosectomy with continuous lavage or a step-up approach of percutaneous drainage and if no clinical improvement then VARD. | |||
|
Drainage as first intervention. Drainage only. Drainage then necrosectomy: laparotomy = 25; VARD = 44; ETN = 7. Van Santvoort HC, et al. (2011) |
130 54 76 |
26 (20%) 9 (16.7%) 17 (22.4%) |
NA | NA | NA | From 639 consecutive patients 2004–2008, in 21 Dutch hospitals; pancreatic necrosis in 324 (51%); infected in 202 (31.6%). Percutaneous, n = 113; endoscopic transluminal (n = 17). |
| Open necrosectomy | ||||||
|
Open necrosectomy with closed continuous lavage. Beger HG et al. (1988) |
95 | 8 (8.4%) | 37/89 (42%) | NA | NA | Single-center 744 consecutive patients, Ulm Germany, 1982–1987; 567 with edematous pancreatitis (4 deaths, 0.7%). |
|
Re-operated on demand = 196 (72.6%); planned re-laparotomies − 74 (27.4%); all drainage by open packing, laparostomy, or both. Götzinger P et al. (2002) |
340 | 133 (39.1%) | 154 (45.3%) | 340 (100%) | 340 (100%) | Prospective consecutive patients needing surgery from two hospitals in Vienna Austria for severe acute pancreatitis, all needing ITU. An additional 101 (29.7%) patients developed infected necrosis. |
|
Open necrosectomy followed by closed packing and drainage. Total Infected Sterile Rodriguez JR et al. (2008) |
167 113 45 |
19 (11.4%) 17 (15.0%) 2 (4.4%) |
113 (67.7%) 113 0 |
NA NA |
92 (55.5%) 72 (63.7%) 20 (44.4%) |
Single-center series MGH, Boston, USA, 1990–2005 of 2449 consecutive patients with acute pancreatitis, 167 (6.8%) with surgical necrotizing pancreatitis. |
|
Open necrosectomy with closed continuous lavage. Van Santvoort HC, et al. (2010) |
45 | 7 (15.6%) | 42 (93%) | 21 (47%) | NA | PANTER multicenter Dutch trial (n = 88) randomized to open necrosectomy with continuous lavage (n = 45) or step-up using percutaneous drainage and if no clinical improvement then VARD (n = 43). |
| van Santvoort HC, et al. (2011) | 68 | 48 (70.6%) | NA | NA | NA | From 639 consecutive patients 2004–2008, in 21 Dutch hospitals; pancreatic necrosis 324 (51%); infected necrosis 202 (31.6%). |
|
Open necrosectomy with closed continuous lavage. Gomatos IP et al. (2016) |
120 | 28 (23.3%) | 60 (50%) | 36 (30%) | 90 (75%) | From consecutive 394 Patients, single-center series, Liverpool, 1996–2013 inclusive. |
| Van Brunschot S, Hollemans RA, et al. (2018) | 376 | 87 (23.1%) | 333(88.6%) | NA | NA | Retrospective data of 1167 patients from 51 hospitals in 15 cohorts; 198 patients derived after matching. |
|
Open necrosectomy with drains but no lavage; reoperation on demand. Husu JL et al. (2020) |
109 | 25 (22.9%) | 85 (78.0%) | 44 (44.4%) | NA | Retrospective single-center consecutive series, Meilahti Hospital, Helsinki Finland, 2006–2017; 52 (47.7%) patients had a reoperation; 27 (24.8%) had a re-necrosectomy < 6 months of the index operation. |
|
Open necrosectomy followed by closed packing and drainage. Luckhurst CM et al. (2020) |
88 | 9 (10.2%) | 63 (71.6%) | NA | 55 (62.5%) | Single-center series MGH, Boston, USA, 2006–2019 of 179 consecutive patients with necrotizing pancreatitis treated either by open necrosectomy (n = 88) or minimally invasive surgery (n = 91): ETN = 29; STE = 14; ETN + STE = 10; VARD = 7; other = 16. |
| Left flank necrosectomy | ||||||
|
Total. Primary procedure. Previously failed surgery. Fagniez PL et al. (1989) |
40 22 18 |
13 (32.5%) 4 (18.2%) 9 (50%) |
18 (45%) NA NA |
40 (100%) 22 (100%) 18 (100%) |
40 (100%) 22 (100%) 18 (100%) |
Consecutive single-center series Créteil, France; 22 operated on primarily; 18 had failed pancreatic surgery elsewhere |
| Minimal access retroperitoneal pancreatic necrosectomy (MARPN) | ||||||
| Carter R et al. (2000) | 14 | 2 (14.3%) | 14 (100%) | 7(50%) | 8 (57.1%) | 14 consecutive patients, single-center series, Glasgow, UK. |
| Gomatos IP et al. (2016) | 274 | 42 (15.3%) | 162 (59.1%) | 103 (37.6%) | 112 (40.9%) | From consecutive 394 Patients, single-center series, Liverpool, UK, 1996–2013 inclusive. Mortality 2009–2013 inclusive = 13 of 124 (10.5%) patients. |
| Wang PF et al. (2018) | 18 | 0 (0%) | 18 (100%) | NA | NA | Single-center series, Beijing, China, during 2017: 9 patients had moderately severe acute pancreatitis, and the other 9 patients had severe acute pancreatitis. |
| Video-assisted retroperitoneal debridement (VARD) | ||||||
|
VARD following catheter drainage. Van Santvoort HC, et al. (2010). |
26 | 6 (23.1%) | NA | NA | NA | PANTER multicenter Dutch trial (n = 88) randomized to open necrosectomy (n = 45) with continuous lavage or a step-up using percutaneous drainage and if no clinical improvement then VARD (n = 43). |
| Endoscopic transgastric necrosectomy (ETN) | ||||||
| Van Brunschot S, Hollemans RA, et al. (2018) | 198 | 17 (8.6%) | 135 (68.2%) | NA | NA | Retrospective data of 1167 patients from 51 hospitals in 15 cohorts; 198 patients derived after matching. |
ITU, intensive therapy unit; VARD, video-assisted retroperitoneal debridement; ETN, endoscopic transgastric necrosectomy; STE, sinus tract endoscopy; MARPN, minimal access retroperitoneal pancreatic necrosectomy
*Infected pancreatic necrosis diagnosed prior to intervention or during the first intervention