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Author Spotlight: Advancements in Retroperitoneal Approach for Necrotizing Pancreatitis
Published on: March 15, 2024
Long-Term Outcome of Immediate Versus Postponed Intervention in Patients With Infected Necrotizing Pancreatitis
Charlotte L Van Veldhuisen1,2,3, Noor J Sissingh3,4, Lotte Boxhoorn2,5
1Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
For infected necrotizing pancreatitis, a postponed-drainage approach using antibiotics leads to fewer interventions long-term compared to immediate drainage. This strategy is recommended for better patient management and fewer procedures.
Area of Science:
- Gastroenterology
- Surgical Outcomes
- Infectious Diseases
Background:
- Infected necrotizing pancreatitis presents complex management challenges.
- The POINTER trial previously suggested fewer interventions with postponed drainage.
Purpose of the Study:
- To compare long-term outcomes of immediate versus postponed drainage in infected necrotizing pancreatitis.
- To evaluate the need for interventions and overall patient status after initial treatment.
Main Methods:
- Re-evaluation of clinical data from patients alive after 6 months.
- Primary outcome: composite of death and major complications.
- Median follow-up of 51 months.
Main Results:
- No significant difference in the primary outcome (death/major complications) between groups (15% vs. 17%).
- Postponed drainage group required fewer additional drainage procedures (7% vs. 15%).
- Significantly fewer total interventions in the postponed-drainage group over the entire follow-up (median 1 vs. 4).
Conclusions:
- A postponed-drainage approach with antibiotics is associated with fewer interventions in the long term.
- This approach should be preferred for managing infected necrotizing pancreatitis.
- Long-term pancreatic function and quality of life were similar between groups.
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