Contemporary Surgical Management of Pancreatic Necrosis

Maurer, Lydia R.; Fagenholz, Peter J.

doi:10.1001/jamasurg.2022.5695

Cited by 8 publications

(3 citation statements)

References 58 publications

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“…The approach of INP management has evolved significantly over the last 20 years and continues to evolve as experience, new techniques, and research data accumulate 5 . For suspected or confirmed INP, the ‘step-up’ approach, an optimal interventional strategy for draining/debriding the necrosis collection including catheter drainage (CD), minimally invasive necrosectomy (MIN), and open necrosectomy (ON), has been suggested in the IAP (International Association of Pancreatology)/APA (American Pancreatic Association) evidence-based guidelines 1 , 6 – 8 .…”

Section: Introductionmentioning

confidence: 99%

Nomogram development and validation for predicting minimally invasive step-up approach failure in infected necrotizing pancreatitis patients: a retrospective cohort study

Cao

et al. 2023

International Journal of Surgery

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Background: Previous studies have shown that minimally invasive treatment for infected necrotizing pancreatitis (INP) may be safer and more effective than open necrosectomy (ON), but ON is still irreplaceable in a portion of INP patients. Furthermore, there is a lack of tools to identify INP patients at risk of minimally invasive step-up approach failure (eventually received ON or died), which may enable appropriate treatment for them. Our study aims to identify risk factors that can predict minimally invasive step-up approach failure in INP patients and to develop a nomogram for early prediction. Methods: Multivariate logistic regression was performed to evaluate the association between minimally invasive step-up approach failure and factors regarding demographics, disease severity, laboratory index, and the location of extrapancreatic necrotic collections. A novel nomogram was developed, and its performance was validated both internally and externally by its discrimination, calibration, and clinical usefulness. Results: There were 267, 89, and 107 patients in the training, internal, and external validation cohorts, respectively. Multivariate logistic regression demonstrated that the computed tomography severity index (CTSI) greater than 8 points, Acute Physiology and Chronic Health Evaluation II (APACHE II) score of 16 points or more, early spontaneous bleeding, fungi infection, granulocyte and platelet decrease within 30 days of acute pancreatitis onset, and extrapancreatic necrosis collection located in small bowel mesentery were independent risk factors for minimally invasive step-up approach failure. The area under the curve and coefficient of determination (R 2) of the nomogram constructed from the above factors were 0.920 and 0.644, respectively. The Hosmer–Lemeshow test showed that the model had good fitness (P=0.206). In addition, the nomogram performed well in both the internal and external validation cohorts. Conclusions: The nomogram had a good performance in predicting minimally invasive step-up approach failure, which may help clinicians distinguish INP patients at risk of minimally invasive step-up approach failure early.

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Section: Introductionmentioning

confidence: 99%

Nomogram development and validation for predicting minimally invasive step-up approach failure in infected necrotizing pancreatitis patients: a retrospective cohort study

Cao

et al. 2023

International Journal of Surgery

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“…Open surgical debridement involves removing necrotic tissue through a surgical incision. Minimally invasive procedures like video-assisted retroperitoneal debridement (VARD) or endoscopic necrosectomy are also used to remove necrotic tissue [24].…”

Section: Pancreatic Necrosismentioning

confidence: 99%

Late Complications of Acute Pancreatitis: A Surgical Approach

Coral

2023

OAJS

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Acute pancreatitis, a severe inflammatory pancreas disorder, often leads to significant morbidity and mortality due to its late complications, including fluid collections, pseudocysts, necrosis, obstruction, fistulation, and abdominal compartment syndrome. Despite its rising incidence and associated healthcare costs, the surgical management of these complications remains a clinical challenge due to the complex nature of the disease and patient comorbidities. Current literature provides an understanding of the pathophysiology, epidemiology, and standard management of these complications. However, there's a need to focus on the surgical approach to address these complications more effectively. This article reviewed these late complications and discussed their clinical presentation and diagnostic methods, emphasizing surgical management and prognosis. The primary goal of the review was to provide clinicians with a comprehensive understanding of the surgical management of these complications, thereby improving patient outcomes. Our analytical methods involved a thorough review of current literature, including clinical studies, reviews, and case reports. The review revealed that surgical intervention plays a pivotal role in managing severe or complicated cases. However, the surgical technique choice depends on the complication's type and severity, the patient's overall condition, and the surgeon's expertise. Further research is recommended to develop standardized protocols for the surgical management of these complications.

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“…The global annual incidence is about 34/100,000 people, and the trend is increasing year by year (1). Pancreatic necrosis and intestinal function impairment caused by early acinar cell death are still important causes of severe disease in patients (2,3). Severe acute pancreatitis (SAP) is a common critical condition primarily caused by pancreatic injury and systemic organ damage.…”

Section: Introductionmentioning

confidence: 99%

S1PR2 participates in intestinal injury in severe acute pancreatitis by regulating macrophage pyroptosis

Lin,

Peng,

Zhu

et al. 2024

Front. Immunol.

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BackgroundSevere acute pancreatitis (SAP) is an inflammatory disorder affecting the gastrointestinal system. Intestinal injury plays an important role in the treatment of severe acute pancreatitis. In this study, we mainly investigated the role of S1PR2 in regulating macrophage pyroptosis in the intestinal injury of severe acute pancreatitis.MethodsThe SAP model was constructed using cerulein and lipopolysaccharide, and the expression of S1PR2 was inhibited by JTE-013 to detect the degree of pancreatitis and intestinal tissue damage in mice. Meanwhile, the level of pyroptosis-related protein was detected by western blot, the level of related mRNA was detected by PCR, and the level of serum inflammatory factors was detected by ELISA. In vitro experiments, LPS+ATP was used to construct the pyroptosis model of THP-1. After knockdown and overexpression of S1PR2, the pyroptosis proteins level was detected by western blot, the related mRNA level was detected by PCR, and the level of cell supernatant inflammatory factors were detected by ELISA. A rescue experiment was used to verify the sufficient necessity of the RhoA/ROCK pathway in S1PR2-induced pyroptosis. Meanwhile, THP-1 and FHC were co-cultured to verify that cytokines released by THP-1 after damage could regulate FHC damage.ResultsOur results demonstrated that JTE-013 effectively attenuated intestinal injury and inflammation in mice with SAP. Furthermore, we observed a significant reduction in the expression of pyroptosis-related proteins within the intestinal tissue of SAP mice upon treatment with JTE-013. We confirmed the involvement of S1PR2 in THP-1 cell pyroptosis in vitro. Specifically, activation of S1PR2 triggered pyroptosis in THP-1 cells through the RhoA/ROCK signaling pathway. Moreover, it was observed that inflammatory factors released during THP-1 cell pyroptosis exerted an impact on cohesin expression in FHC cells.ConclusionThe involvement of S1PR2 in SAP-induced intestinal mucosal injury may be attributed to its regulation of macrophage pyroptosis.

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Contemporary Surgical Management of Pancreatic Necrosis

Cited by 8 publications

References 58 publications

Nomogram development and validation for predicting minimally invasive step-up approach failure in infected necrotizing pancreatitis patients: a retrospective cohort study

Nomogram development and validation for predicting minimally invasive step-up approach failure in infected necrotizing pancreatitis patients: a retrospective cohort study

Late Complications of Acute Pancreatitis: A Surgical Approach

S1PR2 participates in intestinal injury in severe acute pancreatitis by regulating macrophage pyroptosis

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