6/29/23, 1:34 AM PANTER Pathway Feedback Search Clinical Topics Home Studies PANTER PANTER Disease Acute pancreatitis Trial question What is the role of minimally invasive step-up approach to treatment in patients with necrotizing pancreatitis and infected necrotic tissue? Study design Multi-center Open label RCT Population Characteristics of study participants 27.0% female N = 88 73.0% male 88 patients (24 female, 64 male) Inclusion criteria: patients with necrotizing pancreatitis and suspected or confirmed infected necrotic tissue Key exclusion criteria: flare-up of chronic pancreatitis, previous exploratory laparotomy during the current episode of pancreatitis, previous drainage or surgery for confirmed or suspected infected necrosis, pancreatitis caused by abdominal surgery, and an acute intraabdominal event Interventions N=43 a step-up approach to management of pancreatic necrosis (starting with drainage followed, if necessary, by videoscopic assisted retroperitoneal debridement) N=45 primary open necrosectomy (maximal necrosectomy by laparotomy) https://web.pathway.md/studies/recMl9ggOeii1lU1S 1/2 6/29/23, 1:34 AM PANTER Pathway Primary outcome Death or major complications 69.0 % 69 51.8 % 40 34.5 % Significant decrease 17.3 % NNT = 3 0.0 % A step-up approach to management of pancreatic necrosis Primary open necrosectomy Significant decrease in death or major complications (40% vs. 69%; RR 0.57, 95% CI 0.38 to 0.87) Secondary outcomes Significant increase in new-onset multiple-organ failure or systemic complications (12% vs. 42%; RR 28, 95% CI 0.11 to 0.67) No significant difference in death (19% vs. 16%; RR 1.2, 95% CI 0.48 to 3.01) Conclusion In patients with necrotizing pancreatitis and suspected or confirmed infected necrotic tissue, a step- up approach to management of pancreatic necrosis were superior to primary open necrosectomy with respect to death or major complications. Reference van Santvoort HC, Besselink MG, Bakker OJ et al. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med. 2010 Apr 22;362(16):1491-502. Open reference URL https://web.pathway.md/studies/recMl9ggOeii1lU1S 2/2