Is necrosectomy obsolete for infected necrotizing pancreatitis? Is a paradigm shift needed?

Table 2 Results of surgical necrosectomy for necrotizing pancreatitis published mainly after 2000

Ref.	Year	Cases(n)	Type (Intend)	PF (%)	Morbidity(%)	Reoperation rate (%) or n/patient	Mortality(%)	Remark
Sterile
Baril et al[20]	2000	1	Open	0.0	0.0	0.0	0.0	1993-1997
Büchler et al[62]	2000	1	Closed+irrigation	?		?	100.0
Rau et al[64]	2005	142	Closed+irrigation	23.0	61.0	43.0	23.0	1992-2001
Howard et al[21]	2007	23	Planned re-lap		78.0	30.0	9.0	Symptomatic
Garg et al[54]	2010	9	Closed+irrigation	> 30.0			55.5	1997-2008
Infected
Baril et al[20]	2000	11	Open	NA	91.0	45.5	9.0	1993-1997
Büchler et al[62]	2000	27	Closed+irrigation	29.0		22.0	18.5	two un-OP excluded
Rau et al[64]	2005	140	Closed+irrigation	30.0	78.0	27.0	27.0	1992-2001
Howard et al[21]	2007	66	Surgery		86.0	33.0	15.0
Garg et al[54]	2010	36	Closed+irrigation		63.0		63.9	1997-2008
van Santvoort et al[15]	2010	45	Closed+irrigation	38.0	69.0	31.0	16.0	RCT; one operation, 42%; 33% need PCD
		24	VARD		65.0		17.0
van Santvoort et al[18]	2011	78	VARD/TEN/OP		64.0		18.0	21 Dutch hospitals
Babu et al[46]	2013	27	Closed+irrigation	22.2	51.9	22.2	40.7	Step-up
Sterile + infected
Smadja and Bismuth[11]	1986	12	Surgery, early				100.0
		15	Surgery, late				27.0
		11	Surgery, elective				0.0
Connor et al[39]	2005	47	Closed+irrigation		95.0		39.0	81% infected
Olakowski et al[65]	2006	144	Open packing		43.0	3-8/patient	21.0	83% infected
Nieuwenhuijs et al[66]	2003	38	Open packing	21.0	89.0	3-70/patient	47.0
		21	Closed+irrigation	14.0	44.0	0-3/patient	33.0
Reddy et al[40]	2006	118	Closed+irrigation	36.0	58.0	22.9	38.1	65.3% infected
Howard et al[21]	2007	102	Planned re-lap
	(1993-2001)	59		49.0	89.0	67.0	18.0	76% infected
	(2002-2005)	43		60.0	72.0	68.0	4.0	72% infected
Rodriguez et al[67]	2008	167	Closed packing	50.0		11.0	11.0	72% infected
Garg et al[54]	2010	45	Closed+irrigation				48.9	1997-2008
Babu et al[68]	2010	28	PCD + surgery				22.0	2000-2008
Doctor et al[22]	2011	61	Open + laproscopy (re-OP 8%)	50.8			9.8	1998-2009; 83.6% INP
Bausch et al[50]	2012	30	Closed+irrigation	16.7	90.0	73.3	63.3	83.3% infected
Madenci et al[23]	2014	68	Closed packing	74.2	> 74.2	14.7	8.8	2006-2009; 63% infected
Wormer et al[24]	2014	1783	Surgical debridement				22.0	1998-2010; nationwide

INP: Infected necrotizing pancreatitis; OP: Operation; PCD: Percutaneous drainage; PF: Pancreatic fistula; RCT: Randomized control study; Re-lap: Re-laparotomy; TEN: Transluminal endoscopic necrosectomy; un-OP: Not operated on; VARD: Video assisted retroperitoneal debridement.