Operative Pancreas Debridement in 2021: Who and When?

Abstract

Introduction: Treatment of necrotizing pancreatitis (NP) has shifted in favor of a minimally invasive step-up approach rather than primary operative pancreatic debridement (OPD). We evaluated the contemporary role of OPD in NP treatment. Methods: Single institution retrospective review of 468 NP patients treated between 2011-2019. Operative pancreatic debridement included video-assisted retroperitoneal debridement (VARD), open and minimally invasive transgastric debridement, and open debridement with external drainage. NP patients whose treatment included OPD were compared with patients treated definitively without OPD. Results: Since 2011, 256/468 (55%) of patients were treated with OPD. Gender and comorbidity profile were similar between groups. Necrotizing pancreatitis etiology was more likely biliary (52% vs 32%) and less likely secondary to alcohol (19% vs 35%) in patients treated with OPD (p<0.001). Computed tomography severity index (CTSI) of pancreatic necrosis was similar between groups; however, infected necrosis was more common in patients who underwent OPD (68% versus 33%, p <0.001). Patients treated with OPD were more likely to have disconnected pancreatic duct syndrome (DPDS) (53% vs 29%, p <0.001). Among patients who underwent OPD during their treatment, 73% underwent OPD as their initial intervention at 73 ± 6 days after disease onset while 27% underwent OPD as salvage therapy at 95 ± 16 days after disease onset, p=0.1. Conclusions: Operative pancreatic debridement remains an important treatment modality in patients with pancreatic necrosis. OPD is employed as either primary or salvage therapy most frequently in patients with NP of biliary etiology, infected necrosis, and patients with disconnected pancreatic duct.