TY - JOUR
T1 - Minimally invasive and endoscopic versus open necrosectomy for necrotising pancreatitis: a pooled analysis of individual data for 1980 patients
AU - van Brunschot, Sandra
AU - Hollemans, Robbert A.
AU - Bakker, Olaf J.
AU - Besselink, Marc G.
AU - Baron, Todd H.
AU - Beger, Hans G.
AU - Boermeester, Marja A.
AU - Bollen, Thomas L.
AU - Bruno, Marco J.
AU - Carter, Ross
AU - French, Jeremy J.
AU - Coelho, Djalma
AU - Dahl, Björn
AU - Dijkgraaf, Marcel G.
AU - Doctor, Nilesh
AU - Fagenholz, Peter J.
AU - Farkas, Gyula
AU - del Castillo, Carlos Fernandez
AU - Fockens, Paul
AU - Freeman, Martin L.
AU - Gardner, Timothy B.
AU - van Goor, Harry
AU - Gooszen, Hein G.
AU - Hannink, Gerjon
AU - Lochan, Rajiv
AU - McKay, Colin J.
AU - Neoptolemos, John P.
AU - Oláh, Atilla
AU - Parks, Rowan W.
AU - Peev, Miroslav P.
AU - Raraty, Michael
AU - Rau, Bettina
AU - Rösch, Thomas
AU - Rovers, Maroeska
AU - Seifert, Hans
AU - Siriwardena, Ajith K.
AU - Horvath, Karen D.
AU - van Santvoort, Hjalmar C.
PY - 2018
Y1 - 2018
N2 - Minimally invasive surgical necrosectomy and endoscopic necrosectomy, compared with open necrosectomy, might improve outcomes in necrotising pancreatitis, especially in critically ill patients. Evidence from large comparative studies is lacking. We combined original and newly collected data from 15 published and unpublished patient cohorts (51 hospitals; 8 countries) on pancreatic necrosectomy for necrotising pancreatitis. Death rates were compared in patients undergoing open necrosectomy versus minimally invasive surgical or endoscopic necrosectomy. To adjust for confounding and to study effect modification by clinical severity, we performed two types of analyses: logistic multivariable regression and propensity score matching with stratification according to predicted risk of death at baseline (low: <5%; intermediate: ≥5% to <15%; high: ≥15% to <35%; and very high: ≥35%). Among 1980 patients with necrotising pancreatitis, 1167 underwent open necrosectomy and 813 underwent minimally invasive surgical (n=467) or endoscopic (n=346) necrosectomy. There was a lower risk of death for minimally invasive surgical necrosectomy (OR, 0.53; 95% CI 0.34 to 0.84; p=0.006) and endoscopic necrosectomy (OR, 0.20; 95% CI 0.06 to 0.63; p=0.006). After propensity score matching with risk stratification, minimally invasive surgical necrosectomy remained associated with a lower risk of death than open necrosectomy in the very high-risk group (42/111 vs 59/111; risk ratio, 0.70; 95% CI 0.52 to 0.95; p=0.02). Endoscopic necrosectomy was associated with a lower risk of death than open necrosectomy in the high-risk group (3/40 vs 12/40; risk ratio, 0.27; 95% CI 0.08 to 0.88; p=0.03) and in the very high-risk group (12/57 vs 28/57; risk ratio, 0.43; 95% CI 0.24 to 0.77; p=0.005). In high-risk patients with necrotising pancreatitis, minimally invasive surgical and endoscopic necrosectomy are associated with reduced death rates compared with open necrosectomy
AB - Minimally invasive surgical necrosectomy and endoscopic necrosectomy, compared with open necrosectomy, might improve outcomes in necrotising pancreatitis, especially in critically ill patients. Evidence from large comparative studies is lacking. We combined original and newly collected data from 15 published and unpublished patient cohorts (51 hospitals; 8 countries) on pancreatic necrosectomy for necrotising pancreatitis. Death rates were compared in patients undergoing open necrosectomy versus minimally invasive surgical or endoscopic necrosectomy. To adjust for confounding and to study effect modification by clinical severity, we performed two types of analyses: logistic multivariable regression and propensity score matching with stratification according to predicted risk of death at baseline (low: <5%; intermediate: ≥5% to <15%; high: ≥15% to <35%; and very high: ≥35%). Among 1980 patients with necrotising pancreatitis, 1167 underwent open necrosectomy and 813 underwent minimally invasive surgical (n=467) or endoscopic (n=346) necrosectomy. There was a lower risk of death for minimally invasive surgical necrosectomy (OR, 0.53; 95% CI 0.34 to 0.84; p=0.006) and endoscopic necrosectomy (OR, 0.20; 95% CI 0.06 to 0.63; p=0.006). After propensity score matching with risk stratification, minimally invasive surgical necrosectomy remained associated with a lower risk of death than open necrosectomy in the very high-risk group (42/111 vs 59/111; risk ratio, 0.70; 95% CI 0.52 to 0.95; p=0.02). Endoscopic necrosectomy was associated with a lower risk of death than open necrosectomy in the high-risk group (3/40 vs 12/40; risk ratio, 0.27; 95% CI 0.08 to 0.88; p=0.03) and in the very high-risk group (12/57 vs 28/57; risk ratio, 0.43; 95% CI 0.24 to 0.77; p=0.005). In high-risk patients with necrotising pancreatitis, minimally invasive surgical and endoscopic necrosectomy are associated with reduced death rates compared with open necrosectomy
U2 - https://doi.org/10.1136/gutjnl-2016-313341
DO - https://doi.org/10.1136/gutjnl-2016-313341
M3 - Article
C2 - 28774886
SN - 0017-5749
VL - 67
SP - 697
EP - 706
JO - Gut
JF - Gut
ER -