TY - JOUR
T1 - Long-Term Outcome of Immediate Versus Postponed" Intervention in Patients With Infected Necrotizing Pancreatitis" (POINTER)" Multicenter Randomized Trial
AU - van Veldhuisen, Charlotte L.
AU - Sissingh, Noor J.
AU - Boxhoorn, Lotte
AU - van Dijk, Sven M.
AU - van Grinsven, Janneke
AU - Verdonk, Robert C.
AU - Boermeester, Marja A.
AU - Bouwense, Stefan A. W.
AU - Bruno, Marco J.
AU - Cappendijk, Vincent C.
AU - van Duijvendijk, Peter
AU - van Eijck, Casper H. J.
AU - Fockens, Paul
AU - van Goor, Harry
AU - Hadithi, Muhammed
AU - Haveman, Jan Willem
AU - Jacobs, Maarten A. J. M.
AU - Jansen, Jeroen M.
AU - Kop, Marnix P. M.
AU - Manusama, Eric R.
AU - Mieog, J. D. Sven
AU - Molenaar, I. Quintus
AU - Nieuwenhuijs, Vincent B.
AU - Poen, Alexander C.
AU - Poley, Jan-Werner
AU - Quispel, Rutger
AU - Romkens, Tessa E. H.
AU - Schwartz, Matthijs P.
AU - Seerden, Tom C.
AU - Dijkgraaf, Marcel G. W.
AU - Stommel, Martijn W. J.
AU - Straathof, Jan Willem A.
AU - Venneman, Niels G.
AU - Voermans, Rogier P.
AU - van Hooft, Jeanin E.
AU - GROUP
AU - van Santvoort, Hjalmar C.
AU - Besselink, Marc G.
N1 - Publisher Copyright: Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.
PY - 2024/4/1
Y1 - 2024/4/1
N2 - Objective: To compare the long-term outcomes of immediate drainage versus the postponed-drainage approach in patients with infected necrotizing pancreatitis. Background: In the randomized POINTER trial, patients assigned to the postponed-drainage approach using antibiotic treatment required fewer interventions, as compared with immediate drainage, and over a third were treated without any intervention. Methods: Clinical data of those patients alive after the initial 6-month follow-up were re-evaluated. The primary outcome was a composite of death and major complications. Results: Out of 104 patients, 88 were re-evaluated with a median followup of 51 months. After the initial 6-month follow-up, the primary outcome occurred in 7 of 47 patients (15%) in the immediate-drainage group and 7 of 41 patients (17%) in the postponed-drainage group (RR 0.87, 95% CI 0.33-2.28; P=0.78). Additional drainage procedures were performed in 7 patients (15%) versus 3 patients (7%) (RR 2.03; 95% CI 0.56-7.37; P=0.34). The median number of additional interventions was 0 (IQR 0-0) in both groups (P=0.028). In the total follow-up, the median number of interventions was higher in the immediate-drainage group than in the postponed-drainage group (4 vs. 1, P=0.001). Eventually, 14 of 15 patients (93%) in the postponed-drainage group who were successfully treated in the initial 6-month follow-up with antibiotics and without any intervention remained without intervention. At the end of follow-up, pancreatic function and quality of life were similar. Conclusions: Also, during long-term follow-up, a postponed-drainage approach using antibiotics in patients with infected necrotizing pancreatitis results in fewer interventions as compared with immediate drainage and should therefore be the preferred approach.
AB - Objective: To compare the long-term outcomes of immediate drainage versus the postponed-drainage approach in patients with infected necrotizing pancreatitis. Background: In the randomized POINTER trial, patients assigned to the postponed-drainage approach using antibiotic treatment required fewer interventions, as compared with immediate drainage, and over a third were treated without any intervention. Methods: Clinical data of those patients alive after the initial 6-month follow-up were re-evaluated. The primary outcome was a composite of death and major complications. Results: Out of 104 patients, 88 were re-evaluated with a median followup of 51 months. After the initial 6-month follow-up, the primary outcome occurred in 7 of 47 patients (15%) in the immediate-drainage group and 7 of 41 patients (17%) in the postponed-drainage group (RR 0.87, 95% CI 0.33-2.28; P=0.78). Additional drainage procedures were performed in 7 patients (15%) versus 3 patients (7%) (RR 2.03; 95% CI 0.56-7.37; P=0.34). The median number of additional interventions was 0 (IQR 0-0) in both groups (P=0.028). In the total follow-up, the median number of interventions was higher in the immediate-drainage group than in the postponed-drainage group (4 vs. 1, P=0.001). Eventually, 14 of 15 patients (93%) in the postponed-drainage group who were successfully treated in the initial 6-month follow-up with antibiotics and without any intervention remained without intervention. At the end of follow-up, pancreatic function and quality of life were similar. Conclusions: Also, during long-term follow-up, a postponed-drainage approach using antibiotics in patients with infected necrotizing pancreatitis results in fewer interventions as compared with immediate drainage and should therefore be the preferred approach.
KW - antibiotics
KW - clinical outcomes
KW - delayed
KW - drainage
KW - early
KW - infected necrotizing pancreatitis
KW - necrosectomy
KW - timing of intervention
UR - http://www.scopus.com/inward/record.url?scp=85187198614&partnerID=8YFLogxK
U2 - 10.1097/SLA.0000000000006001
DO - 10.1097/SLA.0000000000006001
M3 - Article
C2 - 37450701
SN - 0003-4932
VL - 279
SP - 671
EP - 678
JO - Annals of surgery
JF - Annals of surgery
IS - 4
ER -