Treatment of Necrotizing Pancreatitis: Redefining the Role of Surgery
Background Early surgical intervention in necrotizing pancreatitis (NP) is associated with high mortality. Guidelines recommend fine needle aspiration (FNA) in patients with NP and signs of sepsis. Because infection of necrosis is considered an indication for surgery, operations are often performed...
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| Veröffentlicht in: | World journal of surgery 2012-05, Vol.36 (5), p.1142-1147 |
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| container_title | World journal of surgery |
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| creator | Alsfasser, Guido Schwandner, Frank Pertschy, Annette Hauenstein, Karlheinz Foitzik, Thomas Klar, Ernst |
| description | Background
Early surgical intervention in necrotizing pancreatitis (NP) is associated with high mortality. Guidelines recommend fine needle aspiration (FNA) in patients with NP and signs of sepsis. Because infection of necrosis is considered an indication for surgery, operations are often performed early. We changed treatment toward a conservative approach with FNA in selected cases only, thereby reducing the rate of necrosectomy.
Methods
Retrospectively analyzed patients, all operated on for FNA-proven infection of pancreatic necrosis (
n
= 20, group 1) were compared to patients subjected to conservative treatment (
n
= 24, group 2) who were followed prospectively.
Results
Prognostic scores did not differ between the two groups, indicating comparable severity: the Acute Physiology and Chronic Health Evaluation (APACHE II) score was 19.8 ± 1.7 versus 16 ± 2.2; the Sequential Organ Failure Assessment (SOFA) score was 8.7 ± 1.4 versus 6.9 ± 1.0, the C-reactive protein (CRP) level on day 3 was 243 ± 21 versus 291 ± 21, and the CTSI (CT severity index) was 7.8 ± 0.5 versus 7.9 ± 0.4 (
p
= ns). Ten patients in group 2 underwent operation because of severe extrapancreatic complications. Mortality differed significantly (45% in group 1 vs. 8.3% in group 2;
p
= 0.01).
Conclusions
A highly conservative approach avoiding open necrosectomy in NP results in significantly lower mortality than previous serial FNA and consecutive indication for surgery in case of proven infection. Open surgery in NP should be reserved for concomitant intra-abdominal complications. |
| doi_str_mv | 10.1007/s00268-012-1504-5 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_993101267</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2627928551</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4209-599f2685006df51468f7485ffffb57a39c3bd1ce9eb0ad6555cd8d025eeca2593</originalsourceid><addsrcrecordid>eNqFkEtLxDAUhYMozvj4AW6kuHFVvUmatHGn4hNRmVFchja9HSuddkxaZPz1ptQHCGI2N3DPOZz7EbJD4YACxIcOgMkkBMpCKiAKxQoZ04izkHHGV8kYuIz8n_IR2XDuBYDGEuQ6GTHGExZLMSZnDxbTdo51GzRFcIvGNm35Xtaz4D6tTb8r29IdBRPMsSjrftE-YzBpKuwN087O0C63yFqRVg63P-cmeTw_ezi9DG_uLq5Oj29CEzFQoVCq8IUFgMwLQSOZFHGUiMK_TMQpV4ZnOTWoMIM0l0IIkyc5MIFoUiYU3yT7Q-7CNq8dulbPS2ewqtIam85ppTj1NGTslXu_lC9NZ2tfTquYsjiJJPciOoj81c5ZLPTClvPULjUF3RPWA2HtM3VPWAvv2f0M7rI55t-OL6ReoAbBW1nh8v9E_XQ9PTkHkST9fWzwOm-rPdmf1n83-gCVvZXv</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>971278463</pqid></control><display><type>article</type><title>Treatment of Necrotizing Pancreatitis: Redefining the Role of Surgery</title><source>MEDLINE</source><source>Wiley Online Library All Journals</source><source>SpringerLink Journals - AutoHoldings</source><creator>Alsfasser, Guido ; Schwandner, Frank ; Pertschy, Annette ; Hauenstein, Karlheinz ; Foitzik, Thomas ; Klar, Ernst</creator><creatorcontrib>Alsfasser, Guido ; Schwandner, Frank ; Pertschy, Annette ; Hauenstein, Karlheinz ; Foitzik, Thomas ; Klar, Ernst</creatorcontrib><description>Background
Early surgical intervention in necrotizing pancreatitis (NP) is associated with high mortality. Guidelines recommend fine needle aspiration (FNA) in patients with NP and signs of sepsis. Because infection of necrosis is considered an indication for surgery, operations are often performed early. We changed treatment toward a conservative approach with FNA in selected cases only, thereby reducing the rate of necrosectomy.
Methods
Retrospectively analyzed patients, all operated on for FNA-proven infection of pancreatic necrosis (
n
= 20, group 1) were compared to patients subjected to conservative treatment (
n
= 24, group 2) who were followed prospectively.
Results
Prognostic scores did not differ between the two groups, indicating comparable severity: the Acute Physiology and Chronic Health Evaluation (APACHE II) score was 19.8 ± 1.7 versus 16 ± 2.2; the Sequential Organ Failure Assessment (SOFA) score was 8.7 ± 1.4 versus 6.9 ± 1.0, the C-reactive protein (CRP) level on day 3 was 243 ± 21 versus 291 ± 21, and the CTSI (CT severity index) was 7.8 ± 0.5 versus 7.9 ± 0.4 (
p
= ns). Ten patients in group 2 underwent operation because of severe extrapancreatic complications. Mortality differed significantly (45% in group 1 vs. 8.3% in group 2;
p
= 0.01).
Conclusions
A highly conservative approach avoiding open necrosectomy in NP results in significantly lower mortality than previous serial FNA and consecutive indication for surgery in case of proven infection. Open surgery in NP should be reserved for concomitant intra-abdominal complications.</description><identifier>ISSN: 0364-2313</identifier><identifier>EISSN: 1432-2323</identifier><identifier>DOI: 10.1007/s00268-012-1504-5</identifier><identifier>PMID: 22382765</identifier><language>eng</language><publisher>New York: Springer-Verlag</publisher><subject>Abdominal Surgery ; Acute Pancreatitis ; Algorithms ; Biopsy, Fine-Needle ; Cardiac Surgery ; Decision Support Techniques ; Drainage ; Female ; Fine Needle Aspiration ; General Surgery ; Health Status Indicators ; Humans ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Multiple Organ Failure ; Pancreas - pathology ; Pancreas - surgery ; Pancreatitis ; Pancreatitis, Acute Necrotizing - mortality ; Pancreatitis, Acute Necrotizing - pathology ; Pancreatitis, Acute Necrotizing - surgery ; Pancreatitis, Acute Necrotizing - therapy ; Retrospective Studies ; Sequential Organ Failure Assessment ; Surgery ; Thoracic Surgery ; Treatment Outcome ; Vascular Surgery</subject><ispartof>World journal of surgery, 2012-05, Vol.36 (5), p.1142-1147</ispartof><rights>Société Internationale de Chirurgie 2012</rights><rights>2012 The Author(s) under exclusive licence to Société Internationale de Chirurgie</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4209-599f2685006df51468f7485ffffb57a39c3bd1ce9eb0ad6555cd8d025eeca2593</citedby><cites>FETCH-LOGICAL-c4209-599f2685006df51468f7485ffffb57a39c3bd1ce9eb0ad6555cd8d025eeca2593</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00268-012-1504-5$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00268-012-1504-5$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,41488,42557,45574,45575,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22382765$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Alsfasser, Guido</creatorcontrib><creatorcontrib>Schwandner, Frank</creatorcontrib><creatorcontrib>Pertschy, Annette</creatorcontrib><creatorcontrib>Hauenstein, Karlheinz</creatorcontrib><creatorcontrib>Foitzik, Thomas</creatorcontrib><creatorcontrib>Klar, Ernst</creatorcontrib><title>Treatment of Necrotizing Pancreatitis: Redefining the Role of Surgery</title><title>World journal of surgery</title><addtitle>World J Surg</addtitle><addtitle>World J Surg</addtitle><description>Background
Early surgical intervention in necrotizing pancreatitis (NP) is associated with high mortality. Guidelines recommend fine needle aspiration (FNA) in patients with NP and signs of sepsis. Because infection of necrosis is considered an indication for surgery, operations are often performed early. We changed treatment toward a conservative approach with FNA in selected cases only, thereby reducing the rate of necrosectomy.
Methods
Retrospectively analyzed patients, all operated on for FNA-proven infection of pancreatic necrosis (
n
= 20, group 1) were compared to patients subjected to conservative treatment (
n
= 24, group 2) who were followed prospectively.
Results
Prognostic scores did not differ between the two groups, indicating comparable severity: the Acute Physiology and Chronic Health Evaluation (APACHE II) score was 19.8 ± 1.7 versus 16 ± 2.2; the Sequential Organ Failure Assessment (SOFA) score was 8.7 ± 1.4 versus 6.9 ± 1.0, the C-reactive protein (CRP) level on day 3 was 243 ± 21 versus 291 ± 21, and the CTSI (CT severity index) was 7.8 ± 0.5 versus 7.9 ± 0.4 (
p
= ns). Ten patients in group 2 underwent operation because of severe extrapancreatic complications. Mortality differed significantly (45% in group 1 vs. 8.3% in group 2;
p
= 0.01).
Conclusions
A highly conservative approach avoiding open necrosectomy in NP results in significantly lower mortality than previous serial FNA and consecutive indication for surgery in case of proven infection. Open surgery in NP should be reserved for concomitant intra-abdominal complications.</description><subject>Abdominal Surgery</subject><subject>Acute Pancreatitis</subject><subject>Algorithms</subject><subject>Biopsy, Fine-Needle</subject><subject>Cardiac Surgery</subject><subject>Decision Support Techniques</subject><subject>Drainage</subject><subject>Female</subject><subject>Fine Needle Aspiration</subject><subject>General Surgery</subject><subject>Health Status Indicators</subject><subject>Humans</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Multiple Organ Failure</subject><subject>Pancreas - pathology</subject><subject>Pancreas - surgery</subject><subject>Pancreatitis</subject><subject>Pancreatitis, Acute Necrotizing - mortality</subject><subject>Pancreatitis, Acute Necrotizing - pathology</subject><subject>Pancreatitis, Acute Necrotizing - surgery</subject><subject>Pancreatitis, Acute Necrotizing - therapy</subject><subject>Retrospective Studies</subject><subject>Sequential Organ Failure Assessment</subject><subject>Surgery</subject><subject>Thoracic Surgery</subject><subject>Treatment Outcome</subject><subject>Vascular Surgery</subject><issn>0364-2313</issn><issn>1432-2323</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqFkEtLxDAUhYMozvj4AW6kuHFVvUmatHGn4hNRmVFchja9HSuddkxaZPz1ptQHCGI2N3DPOZz7EbJD4YACxIcOgMkkBMpCKiAKxQoZ04izkHHGV8kYuIz8n_IR2XDuBYDGEuQ6GTHGExZLMSZnDxbTdo51GzRFcIvGNm35Xtaz4D6tTb8r29IdBRPMsSjrftE-YzBpKuwN087O0C63yFqRVg63P-cmeTw_ezi9DG_uLq5Oj29CEzFQoVCq8IUFgMwLQSOZFHGUiMK_TMQpV4ZnOTWoMIM0l0IIkyc5MIFoUiYU3yT7Q-7CNq8dulbPS2ewqtIam85ppTj1NGTslXu_lC9NZ2tfTquYsjiJJPciOoj81c5ZLPTClvPULjUF3RPWA2HtM3VPWAvv2f0M7rI55t-OL6ReoAbBW1nh8v9E_XQ9PTkHkST9fWzwOm-rPdmf1n83-gCVvZXv</recordid><startdate>201205</startdate><enddate>201205</enddate><creator>Alsfasser, Guido</creator><creator>Schwandner, Frank</creator><creator>Pertschy, Annette</creator><creator>Hauenstein, Karlheinz</creator><creator>Foitzik, Thomas</creator><creator>Klar, Ernst</creator><general>Springer-Verlag</general><general>Springer‐Verlag</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>201205</creationdate><title>Treatment of Necrotizing Pancreatitis: Redefining the Role of Surgery</title><author>Alsfasser, Guido ; Schwandner, Frank ; Pertschy, Annette ; Hauenstein, Karlheinz ; Foitzik, Thomas ; Klar, Ernst</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4209-599f2685006df51468f7485ffffb57a39c3bd1ce9eb0ad6555cd8d025eeca2593</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Abdominal Surgery</topic><topic>Acute Pancreatitis</topic><topic>Algorithms</topic><topic>Biopsy, Fine-Needle</topic><topic>Cardiac Surgery</topic><topic>Decision Support Techniques</topic><topic>Drainage</topic><topic>Female</topic><topic>Fine Needle Aspiration</topic><topic>General Surgery</topic><topic>Health Status Indicators</topic><topic>Humans</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Multiple Organ Failure</topic><topic>Pancreas - pathology</topic><topic>Pancreas - surgery</topic><topic>Pancreatitis</topic><topic>Pancreatitis, Acute Necrotizing - mortality</topic><topic>Pancreatitis, Acute Necrotizing - pathology</topic><topic>Pancreatitis, Acute Necrotizing - surgery</topic><topic>Pancreatitis, Acute Necrotizing - therapy</topic><topic>Retrospective Studies</topic><topic>Sequential Organ Failure Assessment</topic><topic>Surgery</topic><topic>Thoracic Surgery</topic><topic>Treatment Outcome</topic><topic>Vascular Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Alsfasser, Guido</creatorcontrib><creatorcontrib>Schwandner, Frank</creatorcontrib><creatorcontrib>Pertschy, Annette</creatorcontrib><creatorcontrib>Hauenstein, Karlheinz</creatorcontrib><creatorcontrib>Foitzik, Thomas</creatorcontrib><creatorcontrib>Klar, Ernst</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>World journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Alsfasser, Guido</au><au>Schwandner, Frank</au><au>Pertschy, Annette</au><au>Hauenstein, Karlheinz</au><au>Foitzik, Thomas</au><au>Klar, Ernst</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Treatment of Necrotizing Pancreatitis: Redefining the Role of Surgery</atitle><jtitle>World journal of surgery</jtitle><stitle>World J Surg</stitle><addtitle>World J Surg</addtitle><date>2012-05</date><risdate>2012</risdate><volume>36</volume><issue>5</issue><spage>1142</spage><epage>1147</epage><pages>1142-1147</pages><issn>0364-2313</issn><eissn>1432-2323</eissn><abstract>Background
Early surgical intervention in necrotizing pancreatitis (NP) is associated with high mortality. Guidelines recommend fine needle aspiration (FNA) in patients with NP and signs of sepsis. Because infection of necrosis is considered an indication for surgery, operations are often performed early. We changed treatment toward a conservative approach with FNA in selected cases only, thereby reducing the rate of necrosectomy.
Methods
Retrospectively analyzed patients, all operated on for FNA-proven infection of pancreatic necrosis (
n
= 20, group 1) were compared to patients subjected to conservative treatment (
n
= 24, group 2) who were followed prospectively.
Results
Prognostic scores did not differ between the two groups, indicating comparable severity: the Acute Physiology and Chronic Health Evaluation (APACHE II) score was 19.8 ± 1.7 versus 16 ± 2.2; the Sequential Organ Failure Assessment (SOFA) score was 8.7 ± 1.4 versus 6.9 ± 1.0, the C-reactive protein (CRP) level on day 3 was 243 ± 21 versus 291 ± 21, and the CTSI (CT severity index) was 7.8 ± 0.5 versus 7.9 ± 0.4 (
p
= ns). Ten patients in group 2 underwent operation because of severe extrapancreatic complications. Mortality differed significantly (45% in group 1 vs. 8.3% in group 2;
p
= 0.01).
Conclusions
A highly conservative approach avoiding open necrosectomy in NP results in significantly lower mortality than previous serial FNA and consecutive indication for surgery in case of proven infection. Open surgery in NP should be reserved for concomitant intra-abdominal complications.</abstract><cop>New York</cop><pub>Springer-Verlag</pub><pmid>22382765</pmid><doi>10.1007/s00268-012-1504-5</doi><tpages>6</tpages></addata></record> |
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| ispartof | World journal of surgery, 2012-05, Vol.36 (5), p.1142-1147 |
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| language | eng |
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| source | MEDLINE; Wiley Online Library All Journals; SpringerLink Journals - AutoHoldings |
| subjects | Abdominal Surgery Acute Pancreatitis Algorithms Biopsy, Fine-Needle Cardiac Surgery Decision Support Techniques Drainage Female Fine Needle Aspiration General Surgery Health Status Indicators Humans Male Medicine Medicine & Public Health Middle Aged Multiple Organ Failure Pancreas - pathology Pancreas - surgery Pancreatitis Pancreatitis, Acute Necrotizing - mortality Pancreatitis, Acute Necrotizing - pathology Pancreatitis, Acute Necrotizing - surgery Pancreatitis, Acute Necrotizing - therapy Retrospective Studies Sequential Organ Failure Assessment Surgery Thoracic Surgery Treatment Outcome Vascular Surgery |
| title | Treatment of Necrotizing Pancreatitis: Redefining the Role of Surgery |
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