Safety and efficacy of video-assisted retroperitoneal debridement for infected pancreatic collections: a multicenter, prospective, single-arm phase 2 study.
BACKGROUND
The feasibility of video-assisted retroperitoneal debridement (VARD) for infected pancreatic walled-off necrosis is established. We provide prospective data on the safety and efficacy of VARD.


METHODS
Multicenter, prospective, single-arm phase 2 study.


METHODS
Six academic medical centers.


METHODS
We evaluated 40 patients with pancreatic necrosis who had infection determined using Gram stain or culture.


METHODS
Percutaneous drains were placed at enrollment, and computed tomographic scans were repeated at 10 days. Patients who had more than a 75% reduction in collection size were treated with drains. Other patients were treated with VARD. Crossover to open surgery was performed for technical reasons and/or according to surgeon judgment.


METHODS
Efficacy (ie, successful VARD treatment without crossover to open surgery or death) and safety (based on mortality and complication rates). Patients received follow-up care for 6 months.


RESULTS
We enrolled 40 patients (24 men and 16 women) during a 51-month period. Median age was 53 years (range, 32-82 years). Mean (SD) Acute Physiology and Chronic Health Evaluation II score at enrollment was 8.0 (5.1), and median computed tomography severity index score was 8. Of the 40 patients, 24 (60%) were treated with minimally invasive intervention (drains with or without VARD). Nine patients (23%) did not require surgery (drains only). For 31 surgical patients, VARD was possible in 60% of patients. Most patients (81%) required 1 operation. In-hospital 30-day mortality was 2.5% (intent-to-treat). Bleeding complications occurred in 7.5% of patients; enteric fistulas occurred in 17.5%.


CONCLUSIONS
This prospective cohort study supports the safety and efficacy of VARD for infected pancreatic walled-off necrosis. Of the patients, 85% were eligible for a minimally invasive approach. We were able to use VARD in 60% of surgical patients. The low mortality and complication rates compare favorably with open debridement. An unexpected finding was that a reduction in collection size of 75% according to the results of computed tomographic scans at 10 to 14 days predicted the success of percutaneous drainage alone.
Horvath
Karen
K
Department of Surgery, University of Washington, 1959 NE Pacific St., Seattle, WA 98195, USA. khorvath@uw.edu
Freeny
Patrick
P
Escallon
Jaime
J
Heagerty
Patrick
P
Comstock
Bryan
B
Glickerman
David J
DJ
Bulger
Eileen
E
Sinanan
Mika
M
Langdale
Lorrie
L
Kolokythas
Orpheus
O
Andrews
R Torrance
RT
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D003646:Debridement / Q000379:methods*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D020535:Video-Assisted Surgery