Necrotising pancreatitis of the pancreatic remnant (NECROREMNANTITIS): A new definition of severe pancreatitis after pancreatectomy

Introduction:

Recent studies suggested acute postoperative pancreatitis as a separate pancreatic-specific complication following pancreatic resection. However, data on necrotising pancreatitis of the remnant is still limited. We defined NECROREMNATITIS as new terminology and aimed to evaluate parameters of patients undergoing either completion pancreatectomy (CP) or elective total pancreatectomy (TP).

Methods:

Between January 2005 and December 2017, 1750 consecutive patients were entered into a prospective database. One hundred fifty-five patients underwent elective TP, and 79 patients required CP. A matched-pairs-analysis evaluated parameters of TP with patients receiving pancreaticoduodenectomy. Patients with CP were subdivided based on NECROREMNANTITIS.

Results:

There were no significant differences in patient demographics. Although operation time (345 vs. 300; p < 0,05) and intraoperative blood loss (700 vs. 400; p < 0,05) were significantly higher, number of patients with complications (Clavien-Dindo ≥3) was similar in the TP-group. Patients with NECROREMNANTITIS revealed significant differences in terms of the time point of operative revision (8 vs. 11; p < 0,05), and indicated prolonged intensive care (6 vs. 3; p < 0,05) and hospital stay (31 vs. 24; p < 0,05). Major complications (Clavien-Dindo ≥3) (12 (36) vs. 8 (17); p < 0,05), and reoperations within 30 days (11 vs. 9; p < 0,05) were significantly higher.

Conclusion:

Perioperative mortality and morbidity of TP are comparable to that of other pancreatic resection procedures. While patients with NECROREMNANTITIS have increased rates of severe perioperative complications, and overall hospital stay is elongated, universally accepted definitions with a clinically validated grading system are mandatory to enable further evaluation.