The researchers analyzed the impact of a conservative strategy of management in patients with necrotizing pancreatitis.
The idea was to reserve intervention for patients with documented infection or the late complications of organized necrosis.
The findings of the study were reported in the October issue of the Annals of Surgery.
The authors reviewed 1110 consecutive patients with acute pancreatitis, managed at Brigham and Women's Hospital, Boston, between 1995 and 2000. They focused on those with pancreatic necrosis, documented by contrast-enhanced computed tomography.
Fine-needle aspiration, the presence of extraintestinal gas on computed tomography, or both were used to identify infection.
There were 99 (9%) patients with necrotizing pancreatitis treated, with an overall death rate of 14%.
| Few necrotizing pancreatitis patients benefit from aggressive strategies.
|Annals of Surgery|
In 3 patients with underlying medical problems, the decision was made initially not to intervene.
Of the other 62 patients without documented infection, all but 3 were managed conservatively. This group's death rate was 11%. All of the 7 deaths were related to multiorgan failure.
Five patients in this group eventually required surgery for organized necrosis, with no deaths.
Of the 34 patients with infected necrosis, 31 underwent surgery and 3 underwent percutaneous drainage. Only 4 (12%) of these patients died, all of multiorgan failure.
The researchers found that, of the total 11 patients who died, few, if any, would have been candidates for earlier surgical intervention.
Dr Stanley W. Ashley and fellow colleagues from the Brigham and Women's Hospital, said, "These results suggest that conservative strategies can be applied successfully to manage most patients with necrotizing pancreatitis. However, some will eventually require surgery for symptomatic organized necrosis."
"Few, if any, patients seem likely to benefit from a more aggressive strategy," they concluded.