Superiority of Step-up Approach vs Open Necrosectomy in Long-term Follow-up of Patients With Necrotizing Pancreatitis

Robbert A. Hollemans; Olaf J. Bakker; Marja A. Boermeester; Thomas L. Bollen; Koop Bosscha; Marco J. Bruno; Erik Buskens; Cornelis H. Dejong; Peter van Duijvendijk; Casper H. van Eijck; Paul Fockens; Harry van Goor; Wilhelmina M. van Grevenstein; Erwin van der Harst; Joos Heisterkamp; Eric J. Hesselink; Sijbrand Hofker; Alexander P. Houdijk; Tom Karsten; Philip M. Kruyt; Cornelis J. van Laarhoven; Johan S. Lameris; Maarten S. van Leeuwen; Eric R. Manusama; I. Quintus Molenaar; Vincent B. Nieuwenhuijs; Bert van Ramshorst; Daphne Roos; Camiel Rosman; Alexander F. Schaapherder; George P. van der Schelling; Robin Timmer; Robert C. Verdonk; Ralph J. de Wit; Hein G. Gooszen; Marc G. Besselink; Hjalmar C. van Santvoort; Dutch Pancreatitis Study Grp

doi:10.1053/j.gastro.2018.10.045

Superiority of Step-up Approach vs Open Necrosectomy in Long-term Follow-up of Patients With Necrotizing Pancreatitis

Robbert A. Hollemans, Olaf J. Bakker, Marja A. Boermeester, Thomas L. Bollen, Koop Bosscha, Marco J. Bruno, Erik Buskens, Cornelis H. Dejong, Peter van Duijvendijk, Casper H. van Eijck, Paul Fockens, Harry van Goor, Wilhelmina M. van Grevenstein, Erwin van der Harst, Joos Heisterkamp, Eric J. Hesselink, Sijbrand Hofker, Alexander P. Houdijk, Tom Karsten, Philip M. KruytCornelis J. van Laarhoven, Johan S. Lameris, Maarten S. van Leeuwen, Eric R. Manusama, I. Quintus Molenaar, Vincent B. Nieuwenhuijs, Bert van Ramshorst, Daphne Roos, Camiel Rosman, Alexander F. Schaapherder, George P. van der Schelling, Robin Timmer, Robert C. Verdonk, Ralph J. de Wit, Hein G. Gooszen, Marc G. Besselink, Hjalmar C. van Santvoort^*, Dutch Pancreatitis Study Grp

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND & AIMS: In a 2010 randomized trial (the PANTER trial), a surgical step-up approach for infected necrotizing pancreatitis was found to reduce the composite endpoint of death or major complications compared with open necrosectomy; 35% of patients were successfully treated with simple catheter drainage only. There is concern, however, that minimally invasive treatment increases the need for reinterventions for residual peripancreatic necrotic collections and other complications during the long term. We therefore performed a long-term follow-up study. METHODS: We reevaluated all the 73 patients (of the 88 patients randomly assigned to groups) who were still alive after the index admission, at a mean 86 months (+/- 11 months) of follow-up. We collected data on all clinical and health care resource utilization endpoints through this follow-up period. The primary endpoint was death or major complications (the same as for the PANTER trial). We also measured exocrine insufficiency, quality of life (using the Short Form-36 and EuroQol 5 dimensions forms), and Izbicki pain scores. RESULTS: From index admission to long-term follow-up, 19 patients (44%) died or had major complications in the step-up group compared with 33 patients (73%) in the open-necrosectomy group (P = .005). Significantly lower proportions of patients in the step-up group had incisional hernias (23% vs 53%; P = .004), pancreatic exocrine insufficiency (29% vs 56%; P = .03), or endocrine insufficiency (40% vs 64%; P = .05). There were no significant differences between groups in proportions of patients requiring additional drainage procedures (11% vs 13%; P = .99) or pancreatic surgery (11% vs 5%; P = .43), or in recurrent acute pancreatitis, chronic pancreatitis, Izbicki pain scores, or medical costs. Quality of life increased during follow-up without a significant difference between groups. CONCLUSIONS: In an analysis of long-term outcomes of trial participants, we found the step-up approach for necrotizing pancreatitis to be superior to open necrosectomy, without increased risk of reinterventions.

Original language	English
Pages (from-to)	1016-1026
Number of pages	11
Journal	Gastroenterology
Volume	156
Issue number	4
DOIs	https://doi.org/10.1053/j.gastro.2018.10.045
Publication status	Published - Mar 2019

Keywords

Pancreas
Infected Necrosis
Minimally Invasive
Pancreatic Surgery
QUALITY-OF-LIFE
SF-36 HEALTH SURVEY
FECAL ELASTASE-1
MANAGEMENT
EQ-5D
CLASSIFICATION
GUIDELINES
NECROSIS
STATES

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10.1053/j.gastro.2018.10.045

Cite this

Hollemans, R. A., Bakker, O. J., Boermeester, M. A., Bollen, T. L., Bosscha, K., Bruno, M. J., Buskens, E., Dejong, C. H., van Duijvendijk, P., van Eijck, C. H., Fockens, P., van Goor, H., van Grevenstein, W. M., van der Harst, E., Heisterkamp, J., Hesselink, E. J., Hofker, S., Houdijk, A. P., Karsten, T., ... Dutch Pancreatitis Study Grp (2019). Superiority of Step-up Approach vs Open Necrosectomy in Long-term Follow-up of Patients With Necrotizing Pancreatitis. Gastroenterology, 156(4), 1016-1026. https://doi.org/10.1053/j.gastro.2018.10.045

@article{caabee4cde804d2e8237faa91d23bf06,

title = "Superiority of Step-up Approach vs Open Necrosectomy in Long-term Follow-up of Patients With Necrotizing Pancreatitis",

abstract = "BACKGROUND & AIMS: In a 2010 randomized trial (the PANTER trial), a surgical step-up approach for infected necrotizing pancreatitis was found to reduce the composite endpoint of death or major complications compared with open necrosectomy; 35% of patients were successfully treated with simple catheter drainage only. There is concern, however, that minimally invasive treatment increases the need for reinterventions for residual peripancreatic necrotic collections and other complications during the long term. We therefore performed a long-term follow-up study. METHODS: We reevaluated all the 73 patients (of the 88 patients randomly assigned to groups) who were still alive after the index admission, at a mean 86 months (+/- 11 months) of follow-up. We collected data on all clinical and health care resource utilization endpoints through this follow-up period. The primary endpoint was death or major complications (the same as for the PANTER trial). We also measured exocrine insufficiency, quality of life (using the Short Form-36 and EuroQol 5 dimensions forms), and Izbicki pain scores. RESULTS: From index admission to long-term follow-up, 19 patients (44%) died or had major complications in the step-up group compared with 33 patients (73%) in the open-necrosectomy group (P = .005). Significantly lower proportions of patients in the step-up group had incisional hernias (23% vs 53%; P = .004), pancreatic exocrine insufficiency (29% vs 56%; P = .03), or endocrine insufficiency (40% vs 64%; P = .05). There were no significant differences between groups in proportions of patients requiring additional drainage procedures (11% vs 13%; P = .99) or pancreatic surgery (11% vs 5%; P = .43), or in recurrent acute pancreatitis, chronic pancreatitis, Izbicki pain scores, or medical costs. Quality of life increased during follow-up without a significant difference between groups. CONCLUSIONS: In an analysis of long-term outcomes of trial participants, we found the step-up approach for necrotizing pancreatitis to be superior to open necrosectomy, without increased risk of reinterventions.",

keywords = "Pancreas, Infected Necrosis, Minimally Invasive, Pancreatic Surgery, QUALITY-OF-LIFE, SF-36 HEALTH SURVEY, FECAL ELASTASE-1, MANAGEMENT, EQ-5D, CLASSIFICATION, GUIDELINES, NECROSIS, STATES",

author = "Hollemans, {Robbert A.} and Bakker, {Olaf J.} and Boermeester, {Marja A.} and Bollen, {Thomas L.} and Koop Bosscha and Bruno, {Marco J.} and Erik Buskens and Dejong, {Cornelis H.} and {van Duijvendijk}, Peter and {van Eijck}, {Casper H.} and Paul Fockens and {van Goor}, Harry and {van Grevenstein}, {Wilhelmina M.} and {van der Harst}, Erwin and Joos Heisterkamp and Hesselink, {Eric J.} and Sijbrand Hofker and Houdijk, {Alexander P.} and Tom Karsten and Kruyt, {Philip M.} and {van Laarhoven}, {Cornelis J.} and Lameris, {Johan S.} and {van Leeuwen}, {Maarten S.} and Manusama, {Eric R.} and Molenaar, {I. Quintus} and Nieuwenhuijs, {Vincent B.} and {van Ramshorst}, Bert and Daphne Roos and Camiel Rosman and Schaapherder, {Alexander F.} and {van der Schelling}, {George P.} and Robin Timmer and Verdonk, {Robert C.} and {de Wit}, {Ralph J.} and Gooszen, {Hein G.} and Besselink, {Marc G.} and {van Santvoort}, {Hjalmar C.} and {Dutch Pancreatitis Study Grp}",

note = "Funding Information: Funding Funded by the Dutch Digestive Disease Foundation (grant no. CDG12-07). The funder had no role in the study design and the collection, analysis, and interpretation of the data. Publisher Copyright: {\textcopyright} 2019 AGA Institute",

year = "2019",

month = mar,

doi = "10.1053/j.gastro.2018.10.045",

language = "English",

volume = "156",

pages = "1016--1026",

journal = "Gastroenterology",

issn = "0016-5085",

publisher = "Elsevier Saunders",

number = "4",

}

Hollemans, RA, Bakker, OJ, Boermeester, MA, Bollen, TL, Bosscha, K, Bruno, MJ, Buskens, E, Dejong, CH, van Duijvendijk, P, van Eijck, CH, Fockens, P, van Goor, H, van Grevenstein, WM, van der Harst, E, Heisterkamp, J, Hesselink, EJ, Hofker, S, Houdijk, AP, Karsten, T, Kruyt, PM, van Laarhoven, CJ, Lameris, JS, van Leeuwen, MS, Manusama, ER, Molenaar, IQ, Nieuwenhuijs, VB, van Ramshorst, B, Roos, D, Rosman, C, Schaapherder, AF, van der Schelling, GP, Timmer, R, Verdonk, RC, de Wit, RJ, Gooszen, HG, Besselink, MG, van Santvoort, HC & Dutch Pancreatitis Study Grp 2019, 'Superiority of Step-up Approach vs Open Necrosectomy in Long-term Follow-up of Patients With Necrotizing Pancreatitis', Gastroenterology, vol. 156, no. 4, pp. 1016-1026. https://doi.org/10.1053/j.gastro.2018.10.045

TY - JOUR

T1 - Superiority of Step-up Approach vs Open Necrosectomy in Long-term Follow-up of Patients With Necrotizing Pancreatitis

AU - Hollemans, Robbert A.

AU - Bakker, Olaf J.

AU - Boermeester, Marja A.

AU - Bollen, Thomas L.

AU - Bosscha, Koop

AU - Bruno, Marco J.

AU - Buskens, Erik

AU - Dejong, Cornelis H.

AU - van Duijvendijk, Peter

AU - van Eijck, Casper H.

AU - Fockens, Paul

AU - van Goor, Harry

AU - van Grevenstein, Wilhelmina M.

AU - van der Harst, Erwin

AU - Heisterkamp, Joos

AU - Hesselink, Eric J.

AU - Hofker, Sijbrand

AU - Houdijk, Alexander P.

AU - Karsten, Tom

AU - Kruyt, Philip M.

AU - van Laarhoven, Cornelis J.

AU - Lameris, Johan S.

AU - van Leeuwen, Maarten S.

AU - Manusama, Eric R.

AU - Molenaar, I. Quintus

AU - Nieuwenhuijs, Vincent B.

AU - van Ramshorst, Bert

AU - Roos, Daphne

AU - Rosman, Camiel

AU - Schaapherder, Alexander F.

AU - van der Schelling, George P.

AU - Timmer, Robin

AU - Verdonk, Robert C.

AU - de Wit, Ralph J.

AU - Gooszen, Hein G.

AU - Besselink, Marc G.

AU - van Santvoort, Hjalmar C.

AU - Dutch Pancreatitis Study Grp

N1 - Funding Information: Funding Funded by the Dutch Digestive Disease Foundation (grant no. CDG12-07). The funder had no role in the study design and the collection, analysis, and interpretation of the data. Publisher Copyright: © 2019 AGA Institute

PY - 2019/3

Y1 - 2019/3

N2 - BACKGROUND & AIMS: In a 2010 randomized trial (the PANTER trial), a surgical step-up approach for infected necrotizing pancreatitis was found to reduce the composite endpoint of death or major complications compared with open necrosectomy; 35% of patients were successfully treated with simple catheter drainage only. There is concern, however, that minimally invasive treatment increases the need for reinterventions for residual peripancreatic necrotic collections and other complications during the long term. We therefore performed a long-term follow-up study. METHODS: We reevaluated all the 73 patients (of the 88 patients randomly assigned to groups) who were still alive after the index admission, at a mean 86 months (+/- 11 months) of follow-up. We collected data on all clinical and health care resource utilization endpoints through this follow-up period. The primary endpoint was death or major complications (the same as for the PANTER trial). We also measured exocrine insufficiency, quality of life (using the Short Form-36 and EuroQol 5 dimensions forms), and Izbicki pain scores. RESULTS: From index admission to long-term follow-up, 19 patients (44%) died or had major complications in the step-up group compared with 33 patients (73%) in the open-necrosectomy group (P = .005). Significantly lower proportions of patients in the step-up group had incisional hernias (23% vs 53%; P = .004), pancreatic exocrine insufficiency (29% vs 56%; P = .03), or endocrine insufficiency (40% vs 64%; P = .05). There were no significant differences between groups in proportions of patients requiring additional drainage procedures (11% vs 13%; P = .99) or pancreatic surgery (11% vs 5%; P = .43), or in recurrent acute pancreatitis, chronic pancreatitis, Izbicki pain scores, or medical costs. Quality of life increased during follow-up without a significant difference between groups. CONCLUSIONS: In an analysis of long-term outcomes of trial participants, we found the step-up approach for necrotizing pancreatitis to be superior to open necrosectomy, without increased risk of reinterventions.

AB - BACKGROUND & AIMS: In a 2010 randomized trial (the PANTER trial), a surgical step-up approach for infected necrotizing pancreatitis was found to reduce the composite endpoint of death or major complications compared with open necrosectomy; 35% of patients were successfully treated with simple catheter drainage only. There is concern, however, that minimally invasive treatment increases the need for reinterventions for residual peripancreatic necrotic collections and other complications during the long term. We therefore performed a long-term follow-up study. METHODS: We reevaluated all the 73 patients (of the 88 patients randomly assigned to groups) who were still alive after the index admission, at a mean 86 months (+/- 11 months) of follow-up. We collected data on all clinical and health care resource utilization endpoints through this follow-up period. The primary endpoint was death or major complications (the same as for the PANTER trial). We also measured exocrine insufficiency, quality of life (using the Short Form-36 and EuroQol 5 dimensions forms), and Izbicki pain scores. RESULTS: From index admission to long-term follow-up, 19 patients (44%) died or had major complications in the step-up group compared with 33 patients (73%) in the open-necrosectomy group (P = .005). Significantly lower proportions of patients in the step-up group had incisional hernias (23% vs 53%; P = .004), pancreatic exocrine insufficiency (29% vs 56%; P = .03), or endocrine insufficiency (40% vs 64%; P = .05). There were no significant differences between groups in proportions of patients requiring additional drainage procedures (11% vs 13%; P = .99) or pancreatic surgery (11% vs 5%; P = .43), or in recurrent acute pancreatitis, chronic pancreatitis, Izbicki pain scores, or medical costs. Quality of life increased during follow-up without a significant difference between groups. CONCLUSIONS: In an analysis of long-term outcomes of trial participants, we found the step-up approach for necrotizing pancreatitis to be superior to open necrosectomy, without increased risk of reinterventions.

KW - Pancreas

KW - Infected Necrosis

KW - Minimally Invasive

KW - Pancreatic Surgery

KW - QUALITY-OF-LIFE

KW - SF-36 HEALTH SURVEY

KW - FECAL ELASTASE-1

KW - MANAGEMENT

KW - EQ-5D

KW - CLASSIFICATION

KW - GUIDELINES

KW - NECROSIS

KW - STATES

U2 - 10.1053/j.gastro.2018.10.045

DO - 10.1053/j.gastro.2018.10.045

M3 - Article

C2 - 30391468

SN - 0016-5085

VL - 156

SP - 1016

EP - 1026

JO - Gastroenterology

JF - Gastroenterology

IS - 4

ER -