Case Control Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Nov 27, 2021; 13(11): 1372-1389
Published online Nov 27, 2021. doi: 10.4240/wjgs.v13.i11.1372
Comparison of safety, efficacy, and long-term follow-up between “one-step” and “step-up” approaches for infected pancreatic necrosis
Zhi Zheng, Jiong-Di Lu, Yi-Xuan Ding, Yu-Lin Guo, Wen-Tong Mei, Yuan-Xu Qu, Feng Cao, Fei Li
Zhi Zheng, Jiong-Di Lu, Yi-Xuan Ding, Yu-Lin Guo, Wen-Tong Mei, Yuan-Xu Qu, Feng Cao, Fei Li, Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
Author contributions: Zheng Z, Lu JD and Ding YX carried out the studies, participated in collecting data; Zheng Z drafted the manuscript; Guo YL, Mei WT and Qu YX performed the statistical analysis and participated in its design; Cao F and Li F participated in acquisition, analysis, or interpretation of data and revised the manuscript; all authors read and approved the final manuscript.
Supported by Beijing Municipal Science and Technology Commission, Capital Research and Demonstration Application of Clinical Diagnosis and Treatment Technology, No. Z191100006619038 and No. Z171100001017077; and Capital Health Research and Development of Special, No. 2020-1-2012.
Institutional review board statement: This study was approved by the Ethics Committee of Xuan Wu Hospital, Capital Medical University, No. 2020-158.
Informed consent statement: Since this was a retrospective study and only analyzed the clinical data of the patients, the need for informed consent was waived. All patient data were analyzed after anonymization.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fei Li, MD, PhD, Chief Doctor, Deputy Director, Surgeon, Department of General Surgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing 100053, China. feili36@ccmu.edu.cn
Received: July 29, 2021
Peer-review started: July 29, 2021
First decision: October 3, 2021
Revised: October 6, 2021
Accepted: October 27, 2021
Article in press: October 27, 2021
Published online: November 27, 2021
Processing time: 120 Days and 11 Hours
Abstract
BACKGROUND

Although the “Step-up” strategy is the primary surgical treatment for infected pancreatic necrosis, it is not suitable for all such patients. The “One-step” strategy represents a novel treatment, but the safety, efficacy, and long-term follow-up have not yet been compared between these two approaches.

AIM

To compare the safety, efficacy, and long-term follow-up of two surgical approaches to provide a reference for infected pancreatic necrosis treatment.

METHODS

This was a retrospective analysis of infectious pancreatic necrosis patients who underwent “One-step” or “Step-up” necrosectomy at Xuan Wu Hospital, Capital Medical University, from May 2014 to December 2020. The primary outcome was the composite endpoint of severe complications or death. Patients were followed up every 6 mo after discharge until death or June 30, 2021. Statistical analysis was performed using SPSS 21.0 and GraphPad Prism 8.0, and statistical significance was set at P < 0.05.

RESULTS

One-hundred-and-fifty-eight patients were enrolled, of whom 61 patients underwent “One-step” necrosectomy and 97 patients underwent “Step-up” necrosectomy. During the long-term follow-up period, 40 patients in the “One-step” group and 63 patients in the “Step-up” group survived. The time from disease onset to hospital admission (53.69 ± 38.14 vs 32.20 ± 20.75, P < 0.001) and to initial surgical treatment was longer in the “Step-up” than in the “One-step” group (54.38 ± 10.46 vs 76.58 ± 17.03, P < 0.001). Patients who underwent “Step-up” necrosectomy had a longer hospitalization duration (65.41 ± 28.14 vs 52.76 ± 24.71, P = 0.02), and more interventions (4.26 ± 1.71 vs 3.18 ± 1.39, P < 0.001). Postoperative inflammatory indicator levels were significantly lower than preoperative levels in each group. Although the incisional hernia incidence was higher in the “One-step” group, no significant difference was found in the composite outcomes of severe complications or death, new-onset organ failure, postoperative complications, inflammatory indicators, long-term complications, quality of life, and medical costs between the groups (P > 0.05).

CONCLUSION

Compared with the “Step-up” approach, the “One-step” approach is a safe and effective treatment method with better long-term quality of life and prognosis. It also provides an alternative surgical treatment strategy for patients with infected pancreatic necrosis.

Keywords: Acute pancreatitis; Follow-up; Infectious pancreatic necrosis; Safety and efficacy; Surgical approach

Core Tip: This was a retrospective study comparing the safety, efficacy, and long-term follow-up between the “One-step” approach and “Step-up” approach for patients with infected pancreatic necrosis. The results indicated that the “One-step” approach is a safe and effective treatment method, with better long-term quality of life and prognosis, which provides a novel surgical treatment strategy for infected pancreatic necrosis patients.