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

Table 4 Results of drainage without minimal invasive necrosectomy for necrotizing pancreatitis published mainly after 2000

Ref.	Year	Cases(n)	Type(Intend)	Sessions1	Success rate(%)	Morbidity(%)	Reoperationrate (%)	Mortality(%)	Remark
Sterile
Baril et al[20]	2000	13	PCD		92.3		7.7	0.0
Zerem et al[41]	2009	20	Conservative	1.5			15.0	0.0	RCT
		20	PCD	1.4	85.0		15.0	5.0
Infected
Freeny et al[52]	1998	34	PCD	3.3	47.0	26.0	53.0	12.0
Baril et al[20]	2000	25	PCD	1.4	76.0	8.0	18.0	8.0
Baron et al[44]	2002	38	TED + irrigation	2.0 (1-6)	79.0	NA	18.0	5.0
Lee et al[19]	2007	18 WON	PCD + irrigation		83.3	11.0	16.7	5.6	Non-RCT; 32% PF
		5	TED		80.0		20.0	0.0	6% PF
Bruennler et al[42]	2008	80	PCD	(1-14)	43.0	29.0	25.0	34.0	1999-2004; 10 + PCN
Mortelé et al[43]	2009	35	PCD	3.3	49.0	11.0	37.0	17.0
van Santvoort et al[18]	2011	130	PCD	NA	35.0	42.0	58.0	20.0	21 Dutch hospitals
Mukai et al[45]	2014	5 WON	SGTMD		100.0	0.0	0.0	0.0
Sterile + infected
Traverso et al[17]	2005	73	PCD	NA	79.0			11.0
Chang et al[9]	2006	19 WON	MIS Lt. flank	1.0	84.2	10.5	5.2	15.8	80% INP
Babu et al[46]	2013	29	PCD; step-up			20.0		6.8	86% INP
Varadarajulu et al[47]	2011	48 WON	TED		52.1	10.4	35.4	6.5
		12 WON	MTGT		91.7	0.0	0.0	0.0

¹Values are mean or range. INP: Infected necrotizing pancreatitis; MIS: Minimal invasive surgery; MTGT: Multiple transluminal gateway technique; NA: Not available; PCD: Percutaneous drainage; PCN: Percutaneous necrosectomy; PF: Pancreatic fistula; RCT: Randomized control study; SGTMD: Single transluminal gateway transcystic multiple drainage; TED: Transluminal endoscopic drainage; WON: Walled-off necrosis.