Outcomes From Minimal Access Retroperitoneal and Open Pancreatic Necrosectomy in 394 Patients With Necrotizing Pancreatitis

Objective:To examine the outcomes from minimal access retroperitoneal pancreatic necrosectomy (MARPN) and open pancreatic necrosectomy (OPN) for severe necrotizing pancreatitis in a single center.Background:The optimal management of severe pancreatic necrosis is evolving with a few large center single series.Methods:Between 1997 and 2013, patients with necrotizing pancreatitis at the Liverpool Pancreas Center were reviewed. Outcome measures were retrospectively analyzed by intention to treat.Results:There were 394 patients who had either MARPN (274, 69.5%) or OPN (120, 30.5%). Complications occurred in 174 MARPN patients (63.5%) and 98 (81.7%) OPN patients (P<0.001). OPN was associated with increased postoperative multiorgan failure [42 (35%) vs 56 (20.4%), P=0.001] and median (inter-quartile range) Acute Physiology and Chronic Health Evaluation II score 9 (6-11.5) vs 8 (5-11), P<0.001] with intensive care required less frequently in MARPN patients [40.9% (112) vs 75% (90), P<0.001]. The mortality rate was 42 (15.3%) in MARPNs and 28 (23.3%) in OPNs (P=0.064). Both the mortality and the overall complication rates decreased between 1997-2008 and 2008-2013 [49 (23.8%) vs 21 (11.2%) P=0.001, respectively; and 151 (73.3%) vs 121 (64.4%), P=0.080, respectively). Increased mortality was independently associated with age (P<0.001), preoperative intensive care stay (P=0.014), and multiple organ failure (P<0.001); operation before 2008 (P<0.001) and conversion to OPN (P=0.035). MARPN independently reduced mortality odds risk (odds ratio=0.27; 95% confidence interval=0.12-0.57; P<0.001).Conclusions:Increasing experience and advances in perioperative care have led to improvement in outcomes. The role of MARPN in reducing complications and deaths within a multimodality approach remains substantial and should be used initially if feasible.