Increasing age and APACHE II scores are the main determinants of outcome from pancreatic necrosectomy

Abstract

Advanced age and increasing APACHE II score, and a need for postoperative intensive care, were the most important predictors of outcome after pancreatic necrosectomy.

Practice Guidelines in Acute Pancreatitis

“…One possible explanation is that there is considerable variation in the number of patients with severe necrotizing pancreatitis who are referred to individual hospitals for specialized care. In recent series, among the total number of patients with severe pancreatitis who were cared for in referral hospitals, the median percentage of referred patients was 63% (range 32-73%) (55,60,62,64,68,83,106,110,138,156,161,164). In some series (60,62,68), but not all (83,138), patients who were transferred were more seriously ill than those who were admitted directly to the reporting hospital.…”

“…The types of surgery that have generally been recommended have included necrosectomy with closed continuous irrigation via indwelling catheters (47,55,89,104,110,112,119,156,164,169), necrosectomy and open packing (89,104,116,119,156,164,169), or necrosectomy with closed drainage without irrigation (89, 106). There have not been randomized prospective trials comparing these procedures.…”

“…These techniques have generally been reserved for patients with infected pancreatic necrosis who are too ill to undergo prompt surgical debridement (such as those with organ failure and/or serious comorbid disease). The first technique is minimally invasive retroperitoneal necrosectomy (55,101,102,116,156), which uses a percutaneous technique to gain access to the necrotic area, dilatation of the tract to a 30-French size, an operating nephroscope for piecemeal retrieval of solid material, irrigation with high volume lavage, and placement of catheters for long-term continuous irrigation. This technique requires general anesthesia and has not been compared in a prospective fashion to more traditional surgical debridement.…”

“…There is now an increasing consensus that patients with sterile necrosis should continue to be managed medically during the first 2-3 wk for the following reasons. First, there have been several retrospective reports suggesting that a delay in surgical necrosectomy and at times a total avoidance of surgery results in less morbidity and mortality than early surgical debridement (55,60,68,(107)(108)(109)138). Secondly, when sterile necrosis is debrided surgically, a common sequela is the development of infected necrosis and the need for additional surgery (55,91,112,138,160).…”

“…Such a technique is minimally invasive retroperitoneal surgery, which has been used in sterile necrosis as well as infected necrosis (55,102,156). Minimally invasive surgery within the first 2-3 wk of severe sterile necrosis has not been compared prospectively with the continuation of medical therapy and thus far is an evolving technology that has been restricted to research centers.…”