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Minimal Access Retroperitoneal Pancreatic Necrosectomy: Improvement in Morbidity and Mortality With a Less Invasive Approach

Raraty, Michael G. T. PhD, FRCS*; Halloran, Christopher M. MD, FRCS*; Dodd, Susanna MSc*†; Ghaneh, Paula MD, FRCS*; Connor, Saxon FRACS‡; Evans, Jonathan MRCP, DMRD§; Sutton, Robert DPhil, FRCS*; Neoptolemos, John P. MD, FRCS*

doi: 10.1097/SLA.0b013e3181d96c53
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Objective: Comparison of minimal access retroperitoneal pancreatic necrosectomy (MARPN) versus open necrosectomy in the treatment of infected or nonresolving pancreatic necrosis.

Summary of Background Data: Infected pancreatic necrosis may lead to progressive organ failure and death. Minimal access techniques have been developed in an attempt to reduce the high mortality of open necrosectomy.

Methods: This was a retrospective analysis on a prospective data base comprising 189 consecutive patients undergoing MARPN or open necrosectomy (August 1997 to September 2008). Outcome measures included total and postoperative ICU and hospital stays, organ dysfunction, complications and mortality using an intention to treat analysis.

Results: Overall 137 patients underwent MARPN versus open necrosectomy in 52. Median (range) age of the patients was 57.5 (18–85) years; 118 (62%) were male. A total of 131 (69%) patients were tertiary referrals, with a median time to transfer from index hospital of 19 (2–76) days. Etiology was gallstones or alcohol in 129 cases (68%); 98 of 168 (58%) patients had a positive culture at the first procedure. Of the 137 patients, 34 (31%) had postoperative organ failure in the MARPN group, and 39 of 52 (56%) in the open group (P < 0.0001); 59/137 (43%) versus 40/52 (77%), respectively, required postoperative ICU support (P < 0.0001). Of the 137 patients 75 (55%) had complications in the MARPN group and 42 of 52 (81%) in the open group (P = 0.001). There were 26 (19%) deaths in the MARPN group and 20 (38%) following open procedure (P = 0.009). Age (P < 0.0001), preoperative multiorgan failure (P < 0.0001), and surgical procedure (MARPN, P = 0.016) were independent predictors of mortality.

Conclusion: This study has shown significant benefits for a minimal access approach including fewer complications and deaths compared with open necrosectomy.

In this study, 137 patients undergoing minimal access retroperitoneal pancreatic necrosectomy are compared with 52 patients undergoing traditional open necrosectomy. Significant improvement in morbidity and mortality are demonstrated with the use of a less invasive procedure.

From the *Pancreatic Biomedical Research Unit, Royal Liverpool and Broadgreen University Hospital NHS Trust and University of Liverpool, Liverpool, United Kingdom; †Centre for Medical Statistics and Health Evaluation, School of Health Sciences, University of Liverpool, Liverpool, United Kingdom; ‡Department of Surgery, Christchurch Hospital, Canterbury, New Zealand; and §Department of Radiology, Royal Liverpool University Hospital, Liverpool, United Kingdom.

The Pancreas Biomedical Research Unit is funded by the National Institute for Health Research.

Reprints: John P. Neoptolemos, MD, School of Cancer Studies, The Duncan Building, Daulby Street, Liverpool L69 3GA, United Kingdom. E-mail: j.p.neoptolemos@liv.ac.uk.

© 2010 Lippincott Williams & Wilkins, Inc.