title: Primary conservative treatment results in mortality comparable to surgery in patients with infected pancreatic necrosis.
abstract: OBJECTIVE
  The standard treatment for patients with infected pancreatic necrosis (IPN) is surgical necrosectomy. We compared the outcomes of surgical treatment versus primary conservative treatment (patients kept in intensive care unit and treated with antibiotics, organ support, intensive nutritional support, and, if required, percutaneous drainage) among patients with IPN.
  
  
  METHODS
  We performed retrospective comparative (with prospectively acquired database) and prospective observational studies; data were collected from all consecutive patients with acute pancreatitis (n = 804), and those with IPN formed the study group. Patients with IPN were divided into 2 groups on the basis of diagnosis of IPN during 1997-2002 (group 1, n = 30) or 2003-2006 (group 2, n = 50). Eighteen patients in group 1 were treated by surgical necrosectomy, and 40 patients in group 2 were given primary conservative treatment; surgery was performed on patients if conservative treatment failed (n = 10). The primary outcome measure was mortality.
  
  
  RESULTS
  The mortality was comparable in group 1 versus group 2 (43% vs 28%; P = .22). During a period of 10 years, the patients who received primary conservative treatment had significantly higher survival rates than those who received surgery (76.9% vs 46.4%; P = .005). In the prospective study during 2007-2008, the mortality from infected necrosis was 29.6% after primary conservative treatment, confirming the results of the comparative study.
  
  
  CONCLUSIONS
  In treating patients with IPN, a primary conservative strategy resulted in mortality that was comparable with that after surgery, and 76% of the patients were able to avoid surgery; 54.5% of IPN patients were successfully managed with the primary conservative strategy.
authors.affiliation: Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India. pkgarg@aiims.ac.in
authors.forename: Pramod Kumar
authors.initials: PK
authors.lastname: Garg
authors.forename: Manik
authors.initials: M
authors.lastname: Sharma
authors.forename: Kaushal
authors.initials: K
authors.lastname: Madan
authors.forename: Peush
authors.initials: P
authors.lastname: Sahni
authors.forename: Debabrata
authors.initials: D
authors.lastname: Banerjee
authors.forename: Rohit
authors.initials: R
authors.lastname: Goyal
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003646:Debridement; D004322:Drainage / Q000379:methods*; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D011446:Prospective Studies; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents