Management der nekrotisierenden Pankreatitis - Stellenwert der Kolektomie

Management of necrotizing pancreatitis - importance of colectomy

by Marieke Helene Thomsen
Doctoral thesis
Date of Examination:2016-03-14
Date of issue:2016-02-16
Advisor:Prof. Dr. Otto Kollmar
Referee:Prof. Dr. Otto Kollmar
Referee:PD Dr. Ahmad Amanzada
Referee:Prof. Dr. Lutz Trojan
Persistent Address: http://dx.doi.org/10.53846/goediss-5222

 

 

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Abstract

English

The acute necrotizing pancreatitis is a disease with increasing incidence.  Despite improvements in diagnosis, intensive medical therapy and advanced surgical techniques in the last decades, the mortality remains high.  Especially the superinfection of necrosis with consecutive systemic complications leads to secondary organ damage and even multi-organ failure. The colon is considered as a source of bacterial contamination. The aim of this study was to retrospectively compare different concepts of the surgical management of acute necrotizing pancreatitis at two german university hospitals, the University Hospital of Homburg / Saarland and the University Hospital of Göttingen.  Anamnestic and perioperative informations of patients who were treated for acute necrotizing pancreatitis between 2002 and 2012 and needed surgical and intensive care were detected and analyzed for surgical treatment and objective parameters. A total of 56 patients were included in the analysis. The mean age was 57.2 ± 14.9 years. There was no relevant difference between the collectives from Homburg / Saar and Göttingen. Major causes of  pancreatitis were gallstones, alcohol abuse and medical procedures. The hospital mortality in the overall population was 50%, the 30- and 90-day mortality rates were 21.4% and 35.7%. The average length of hospitalization was 70.5 ± 57.0 days.  The subgroup analysis showed that patients after colectomy (n = 9) had a significantly reduced hospital mortality compared to non-colectomy patients (n = 47) (33% vs. 53.2%), but the average length of hospitalization and intensive care of patients with colectomy were longer (86.6 ± 54.3 d vs. 67.3 ± 57.6 d, respectively  52.9 ± 23.7 d vs. 45.6 ± 49.3 d). Colectomy within the first required surgery resulted in a significant reduction in the hospital mortality and 30-day and 90-day mortality.  Time of colectomy after hospital admission or after diagnosis, however, was not decisive for the outcome of the patients.  Comparison of non-colectomy patients at both centers showed no differences in hospital mortality, 30-day and 90-day mortality or the average length of hospitalization and intensive care. In conclusion, patients with complicated acute necrotizing pancreatitis could possibly benefit from an early colectomy. However, because of the small number of cases these results have low statistical power and therefore can not be regarded as a final treatment recommendation.
Keywords: pancreatitis, necrotizing, colectomy
 
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