What's Behind it all: A Retrospective Cohort Study of Retrogastric Pancreatic Necrosis Management.

Autor:	Harrison JM; Section of Hepatobiliary & Pancreatic Surgery Department of General Surgery Stanford University Hospital Stanford, CA 94305-5655., Day H; Stanford-Surgery Policy Improvement Research & Education (S-SPIRE) Department of General Surgery Stanford University Hospital Stanford, CA 94305-5655., Arnow K; Stanford-Surgery Policy Improvement Research & Education (S-SPIRE) Department of General Surgery Stanford University Hospital Stanford, CA 94305-5655., Ngongoni RF; Section of Hepatobiliary & Pancreatic Surgery Department of General Surgery Stanford University Hospital Stanford, CA 94305-5655., Joseph A; Section of Advanced Endoscopy Department of Gastroenterology and Hepatology Stanford University Medical Center Stanford, CA 94305-5655., Aldridge T; Section of Hepatobiliary & Pancreatic Surgery Department of General Surgery Stanford University Hospital Stanford, CA 94305-5655., Wheeler KJ; Section of Hepatobiliary & Pancreatic Surgery Department of General Surgery Stanford University Hospital Stanford, CA 94305-5655., DeLong JC; Section of Hepatobiliary & Pancreatic Surgery Department of General Surgery Stanford University Hospital Stanford, CA 94305-5655., Bergquist JR; Section of Hepatobiliary & Pancreatic Surgery Department of General Surgery Stanford University Hospital Stanford, CA 94305-5655., Worth PJ; Section of Hepatobiliary & Pancreatic Surgery Department of General Surgery Stanford University Hospital Stanford, CA 94305-5655., Dua MM; Section of Hepatobiliary & Pancreatic Surgery Department of General Surgery Stanford University Hospital Stanford, CA 94305-5655., Friedland S; Section of Advanced Endoscopy Department of Gastroenterology and Hepatology Stanford University Medical Center Stanford, CA 94305-5655., Park W; Section of Advanced Endoscopy Department of Gastroenterology and Hepatology Stanford University Medical Center Stanford, CA 94305-5655., Eldika S; Section of Advanced Endoscopy Department of Gastroenterology and Hepatology Stanford University Medical Center Stanford, CA 94305-5655., Hwang JH; Section of Advanced Endoscopy Department of Gastroenterology and Hepatology Stanford University Medical Center Stanford, CA 94305-5655., Visser BC; Section of Hepatobiliary & Pancreatic Surgery Department of General Surgery Stanford University Hospital Stanford, CA 94305-5655.
Jazyk:	angličtina
Zdroj:	Annals of surgery [Ann Surg] 2024 Sep 03. Date of Electronic Publication: 2024 Sep 03.
DOI:	10.1097/SLA.0000000000006521
Abstrakt:	Objective: To compare outcomes of laparoscopic transgastric necrosectomy (LTN) and direct endoscopic necrosectomy (DEN) in the management of retrogastric walled-off necrosis. Summary of Background Data: Surgical and endoscopic transgastric approaches are used to manage retrogastric pancreatic necrosis. Studies comparing these treatment modalities are lacking but would influence contemporary practice patterns. Methods: LTN or DEN treated patients at Stanford University Hospital between 2011 and 2023 were identified. Cohort data included demographics, core pancreatitis care benchmarks, and clinical outcomes (total debridement time, new-onset endocrine and exocrine pancreatic insufficiency) as well as re-intervention, 30-day readmission, complication, and mortality rates. Long-term follow-up was also compared between intervention arms. Multivariable linear regression was used to assess the interaction between admission APACHE-II score and intervention on length of stay (LOS). Results: 106 patients (62% LTN, 38% DEN) were identified. Demographic and core pancreatitis benchmark data were similar between cohorts. 30-day readmission, complication, and mortality rates for surgical and endoscopic approaches were also similar: 23% vs. 25% (P = 0.98), 42% vs. 40% (P = 0.97), and 3% vs. 3% (P > 0.99). Median LTN total debridement time (minutes) was 131 vs. 134 for DEN, however, complete debridement was achieved with only 1 LTN compared to 3 DENs (P<0.01). While not statistically significant, LOS and unplanned intervention rates were less for LTN (8 vs. 10 days, P = 0.41 and 6% vs. 15%, P = 0.24). Multivariable analysis revealed a significant interaction between APACHE-II scores and LOS for LTN compared to DEN, which translated into a length of stay reduction for higher APACHE-II scoring patients (P = 0.02). Conclusions: LTN is a safe and efficient treatment modality for walled-off necrosis, and compared to DEN, can reduce the LOS in high APACHE-II score patients. While additional comparative research between the two intervention types is needed, this study supports a role for a surgical approach in the management of retrogastric pancreatic necrosis. Competing Interests: The authors have no conflicts of interest or financial disclosures to report. (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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