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A “tailored” interventional and surgical management for moderate to critical acute pancreatitis in late phase: a cohort study

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Abstract

Purpose

Several interventional procedures are available to treat moderate-to-critical acute pancreatitis (AP) in its late phase. The ongoing debate on these options, together with the scarcity of reported quality of life (QoL) information in the Literature, prompted us to conduct a review of our experience.

Methods

All the patients treated at our referral Center for moderate-to-critical AP according to Determinant-Based Classification (DBC) were retrospectively reviewed. Patients treated conservatively or operated within 4 weeks were excluded. The included patients were managed following a “tailored” interventional-surgical approach, which did not exclude the possibility to skip one or more steps of the classic “step-up” approach, based on the patient’s clinical course, and divided into four groups, according to the first procedure performed: percutaneous drainage (PD), endoscopic approach (END), internal derivation (INT), and necrosectomy (NE). In-hospital and mid-term follow-up variables were analyzed.

Results

The study sample consisted in 47 patients: 11 patients were treated by PD, 11 by END, 13 by INT, and 12 by NE. A significant distribution of the DBC severity (p = 0.029) was registered among the four groups. Moreover, the NE group had statistically significant reduced SF-36 scores in the domain of social functioning at 3 months (p = 0.011), at 1 year (p = 0.002), and at 2 years (p = 0.001); role limitations due to physical health at 6 months (p = 0.027); and role limitations due to emotional problems at 1 year (p = 0.020).

Conclusions

In the “late phase” of moderate to critical AP requiring an invasive management, PD, END, INT, and NE are all effective options, depending on patents’ status and necrosis location. A “tailored” interventional-surgical management could be pursued, but up-front more invasive approaches are at higher risk of worse QoL.

Trial registration.

The manuscript was registered at clinicaltrials.gov in 04/2021 and identified with NCT04870268.

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Acknowledgements

The authors thank Sharon Bernadette King for the language editing.

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Authors and Affiliations

  1. General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy

    Giulio Di Candio, Simone Guadagni, Niccolò Furbetta, Desirée Gianardi, Matteo Palmeri, Gregorio Di Franco, Matteo Bianchini & Luca Morelli

  2. Interventional and Pediatric Endoscopic Unit, Department of Surgery, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy

    Dario Gambaccini & Emanuele Marciano

  3. Interventional Radiology Division, Imaging Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy

    Rosa Cervelli

  4. Gastroenterology Unit, University of Pisa, Pisa, Italy

    Santino Marchi

Authors
  1. Giulio Di Candio
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  2. Simone Guadagni
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  3. Niccolò Furbetta
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  4. Desirée Gianardi
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  5. Matteo Palmeri
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  6. Gregorio Di Franco
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  7. Matteo Bianchini
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  8. Dario Gambaccini
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  9. Emanuele Marciano
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  10. Rosa Cervelli
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  11. Santino Marchi
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  12. Luca Morelli
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Contributions

Study conception and design: Guadagni, Marciano, Morelli, Marchi, and Di Candio; acquisition of data: Guadagni, Furbetta, Palmeri, Gianardi, and Gambaccini; analysis and interpretation of data: Di Franco, Furbetta, and Cervelli; drafting of the manuscript: Guadagni, Furbetta, Bianchini, Morelli; critical revision: Bianchini, Cervelli, Morelli, and Di Candio.

Corresponding author

Correspondence to Simone Guadagni.

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Ethical standard

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants involved in the study.

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The authors declare no competing interests.

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Di Candio, G., Guadagni, S., Furbetta, N. et al. A “tailored” interventional and surgical management for moderate to critical acute pancreatitis in late phase: a cohort study. Langenbecks Arch Surg 407, 2833–2841 (2022). https://doi.org/10.1007/s00423-022-02557-x

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  • DOI: https://doi.org/10.1007/s00423-022-02557-x

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