Minimal access retroperitoneal pancreatic necrosectomy for infected pancreatic necrosis: A single-center of 15 years' experience

Abstract

Background: Minimal access retroperitoneal pancreatic necrosectomy stands as an effective treatment method for infected pancreatic necrosis. However, its popularity still needs to be improved, and in-depth exploration are needed regarding its indications, complications and efficacy. Therefore, we sought to explore the technical details of minimal access retroperitoneal pancreatic necrosectomy surgery and evaluate its safety and efficacy.

Methods: A retrospective analysis was performed in a prospective maintained database of infected pancreatic necrosis between January 2010 and April 2024 at a large Chinese tertiary hospital.

Results: Of 400 patients with infected pancreatic necrosis, 18.8% (75/400) received only percutaneous catheter drainage, 61.2% (245/400) underwent a minimal-access retroperitoneal pancreatic necrosectomy approach, and 20% (80/400) adopted open pancreatic necrosectomy. The number of patients with infected pancreatic necrosis treated with the minimal access retroperitoneal pancreatic necrosectomy procedure has steadily increased over the past decade, accompanied by a decreasing trend in both the mortality and a composite of major complications or death. Minimal access retroperitoneal pancreatic necrosectomy was associated with a lower incidence of gastrointestinal fistula (33 [13.5%] vs 24 [30%], P < .001), mortality (44 [18%] vs 30 [37.5%], P < .001), and composite of major complications or death (88 [35.9%] vs 46 [57.5%], P < .001) compared with open pancreatic necrosectomy. In total, 6.9% (17/245) of patients in the minimal access retroperitoneal pancreatic necrosectomy group required conversion to open pancreatic necrosectomy due to uncontrolled infection or severe complications, whereas 30% (24/80) of patients in the open pancreatic necrosectomy group needed subsequent minimal access retroperitoneal pancreatic necrosectomy to remove residual necrotic tissue and address evolving necrosis. Multivariate analysis of risk factors of conversion to open pancreatic necrosectomy or death indicated that critical acute pancreatitis (odds ratio, 6.1; 95% confidence interval, 1.8-20.7, P = .004), multiple organ failure (odds ratio, 39.7; 95% confidence interval, 4.1-380.6, P < .001), bloodstream infection (odds ratio, 1.1; 95% confidence interval, 1.1-2.8, P = .007), and hemorrhage (odds ratio, 45; 95% confidence interval, 4.4-457.5, P = .004) were significant factors.

Conclusion: Minimal access retroperitoneal pancreatic necrosectomy is a safe and effective approach for improving the prognosis of patients with infected pancreatic necrosis. Standardized surgical procedures, meticulous technical execution, and individualized management are essential for optimizing the efficacy of minimal access retroperitoneal pancreatic necrosectomy.