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( Rajesh Gupta ),( Aditya Atul Kulkarni ),( Rahul Gupta ),( Sunil Shenvi ),( Tanvi Jain ),( Raghavendra Babu ),( Mandeep Kang ),( Surinder Rana ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1
Aims: Step-up approach is becoming a standard of care for management of acute necrotizing pancreatitis. We aimed to investigate the learning curve effect and increasing experience on management and outcomes of surgical step-up approach at our high-volume tertiary referral center. Methods: In a retrospective analysis of database of patients with acute necrotizing pancreatitis referred to our unit, we divided patients into three distinct time periods: Group-1 (2008-2012), Group-2 (2013-2016) and Group-3 (2017-2019). Outcomes between different time periods were compared. Results: Total of 335 patients were included, with 92 patients in Group-1, 117 in Group-2 and 126 in Group-3. Patients treated on surgical side in later time period had higher incidence of multiorgan failure (26.1% vs. 49.6% vs. 45.2%, P<0.001), APACHE II scores at presentation (8 vs. 10 vs. 9, P=0.006) and at first intervention (9 vs. 11 vs. 10, P=0.037), as well higher mCTSI score (8 vs. 10 vs. 10, P<0.001). Over time, median percutaneous drain size (10Fr vs. 12Fr vs. 14 Fr, P<0.001) as well as sepsis reversal after drainage (40.2% vs. 59% vs. 49.2%, P=0.026) increased, whereas median number of drains (P=0.001) and interventions (4 vs. 3 vs. 3, P=0.005) decreased significantly. Necrosectomy requirement, length of stay and mortality remained similar over time despite more severe cases referred to surgical side. Conclusions: With increasing experience of step-up approach, sicker patients with higher severity of pancreatitis could be managed successfully with fewer drains and procedures leading to significantly higher sepsis reversal with drainage, with no increase in surgery requirement or mortality.