학술논문
Long-Term Outcome of Immediate Versus Postponed Intervention in Patients With Infected Necrotizing Pancreatitis (POINTER): Multicenter Randomized Trial
Document Type
Academic Journal
Author
Van Veldhuisen, Charlotte L.; Sissingh, Noor J.; Boxhoorn, Lotte; van Dijk, Sven M.; van Grinsven, Janneke; Verdonk, Robert C.; Boermeester, Marja A.; Bouwense, Stefan A.W.; Bruno, Marco J.; Cappendijk, Vincent C.; van Duijvendijk, Peter; van Eijck, Casper H J.; Fockens, Paul; van Goor, Harry; Hadithi, Muhammed; Haveman, Jan Willem; Jacobs, Maarten A.J.M.; Jansen, Jeroen M.; Kop, Marnix P.M.; Manusama, Eric R.; Mieog, J. Sven D.; Molenaar, I. Quintus; Nieuwenhuijs, Vincent B.; Poen, Alexander C.; Poley, Jan-Werner; Quispel, Rutger; Römkens, Tessa E.H.; Schwartz, Matthijs P.; Seerden, Tom C.; Dijkgraaf, Marcel G.W.; Stommel, Martijn W.J.; Straathof, Jan Willem A.; Venneman, Niels G.; Voermans, Rogier P.; van Hooft, Jeanin E.; van Santvoort, Hjalmar C.; Besselink, Marc G.
Source
Annals of Surgery. Apr 01, 2024 279(4):671-678
Subject
Language
English
ISSN
0003-4932
Abstract
OBJECTIVE:: To compare the long-term outcomes of immediate drainage versus the postponed-drainage approach in patients with infected necrotizing pancreatitis. BACKGROUND:: In the randomized POINTER trial, patients assigned to the postponed-drainage approach using antibiotic treatment required fewer interventions, as compared with immediate drainage, and over a third were treated without any intervention. METHODS:: Clinical data of those patients alive after the initial 6-month follow-up were re-evaluated. The primary outcome was a composite of death and major complications. RESULTS:: Out of 104 patients, 88 were re-evaluated with a median follow-up of 51 months. After the initial 6-month follow-up, the primary outcome occurred in 7 of 47 patients (15%) in the immediate-drainage group and 7 of 41 patients (17%) in the postponed-drainage group (RR 0.87, 95% CI 0.33–2.28; P=0.78). Additional drainage procedures were performed in 7 patients (15%) versus 3 patients (7%) (RR 2.03; 95% CI 0.56–7.37; P=0.34). The median number of additional interventions was 0 (IQR 0–0) in both groups (P=0.028). In the total follow-up, the median number of interventions was higher in the immediate-drainage group than in the postponed-drainage group (4 vs. 1, P=0.001). Eventually, 14 of 15 patients (93%) in the postponed-drainage group who were successfully treated in the initial 6-month follow-up with antibiotics and without any intervention remained without intervention. At the end of follow-up, pancreatic function and quality of life were similar. CONCLUSIONS:: Also, during long-term follow-up, a postponed-drainage approach using antibiotics in patients with infected necrotizing pancreatitis results in fewer interventions as compared with immediate drainage and should therefore be the preferred approach. TRIAL REGISTRATION:: ISRCTN33682933