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 24 February 2018

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News

Early and late complications after pancreatic necrosectomy

A study in the latest Surgery issue finds that multiorgan failure and postoperative hemorrhage are independent predictors of mortality and that almost all patients undergoing necrosectomy develop both early or late complications.

News image

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Surgery for pancreatic necrosis is associated with a high morbidity and mortality.

Professor Neoptolemos and colleagues from England reviewed the incidence of early and late complications after pancreatic necrosectomy in a large contemporary series of patients.

The researchers reviewed the clinical outcomes of 88 patients who underwent pancreatic necrosectomy between 1997 and 2003.

The team reported that the median age of the patients was 56 years, and 61 % were males.

62 % developed complications, and 16 % of those required surgical or endoscopic intervention
Surgery

The research team also reported that 77 % had primary pancreatic infection and 81 % had more than 50 % necrosis.

The median admission Acute Physiology and Chronic Health Evaluation score of the patients was 9, which had a range of 1-21.

The investigators found that the median time to surgery was 31 days and that 47 patients underwent minimally invasive necrosectomy.

41 patients were reported to have undergone open necrosectomy, 81 patients had complications postoperatively and 25 died.

The investigative team noted that during a median follow-up of 29 months, 39 of 63 surviving patients had one or more late complications including biliary stricture in 4, pseudocyst in 5 and pancreatic fistula in 8.

In addition, the researchers found other complications that included gastrointestinal fistula in 1, delayed collections in 3, and incisional hernia in 1 whilst intervention was required in 10 patients.

The team also observed that 16 of 63 surviving patients developed exocrine insufficiency, and 19 of 58 without prior diabetes mellitus developed endocrine insufficiency.

Professor Neoptolemos and team concludes, “Almost all patients undergoing necrosectomy developed significant early or late complications or both.”

“Multiorgan failure and postoperative hemorrhage were independent predictors of mortality.”

“Long-term follow-up was important because 62 % developed complications, and 16 % of those with complications required surgical or endoscopic intervention.”

Surgery 2005: 137(5): 499
03 May 2005

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