van Brunschot S, et al. – Researchers sought to gain evidence to assess whether minimally invasive surgical necrosectomy and endoscopic necrosectomy, compared with open necrosectomy, could improve outcomes in necrotising pancreatitis, especially in critically ill patients. Findings revealed that in high–risk patients with necrotising pancreatitis, minimally invasive surgical and endoscopic necrosectomy were associated with reduced mortality in comparison to open necrosectomy.

Methods

• Original and newly collected data from 15 published and unpublished patient cohorts (51 hospitals; 8 countries) on pancreatic necrosectomy for necrotising pancreatitis were combined.
• Comparison of death rates was performed in patients undergoing open necrosectomy versus minimally invasive surgical or endoscopic necrosectomy.
• To adjust for confounding and to study effect modification by clinical severity, two types of analyses were performed: 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%).

Results

• 1980 patients with necrotising pancreatitis were identified; 1167 underwent open necrosectomy and 813 underwent minimally invasive surgical (n=467) or endoscopic (n=346) necrosectomy.
• A lower risk of death was observed 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, findings suggested that 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).
• A lower risk of death was observed with endoscopic necrosectomy in comparison to 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).