Is necrosectomy obsolete for infected necrotizing pancreatitis? Is a paradigm shift needed?

Table 3 Results of minimal invasive necrosectomy for walled-off necrotizing pancreatitis published after 2000

Ref.	Year	Cases(n)	Type(Intend)	Sessions1	Completionrate (%)	Morbidity(%)	Reoperationrate (%)	Mortality(%)	Remark
Infected
Raczynski et al[25]	2006	2	TEND + irrigation	3	100.0	0.0	0.0	0.0	2 PEG
									(1st report?)
Escourrou et al[26]	2008	13	TEND + irrigation	1-3	100.0	46.0	0.0	0.0	+ PCD × 2
Bala et al[27]	2009	8	Lt RPD + N+ irrigation	3-17	87.5	25.0		12.5	Stepped
Antillon et al[28]	2009	1	TEN + stent		100.0	0.0	0.0	0.0	Transgastrostomy; Foley irrigation
Will et al[29]	2012	18	TEN ± PCD	3-8	100.0	16.6	0.0	0.0	One unrelated death
Bakker et al[30]	2012	10	TEND	2-6	100.0	20.0	0.0	10.0	RCT; 10% PF
		10	VARD/Lap	1-2	40.0	80.0	60.0	40.0	70% PF
Castellanos et al[31]	2013	32	VARD	1.0	100.0	9.3	0.0	15.6
Sarkaria et al[32]	2014	17	TEN + Stent ± PEG-J + irrigation	5.3	88.0	5.9	11.8	0.0	8 PEG-J
Sterile + infected
Connor et al[39]	2005	47	Lt. RPD + N	1-9		92.0		19.0	81% INP
		(NS)
Voermans et al[33]	2007	25	TEND + irrigation	NA	92.0	40.0	4.0	0.0	76% NP
Papachristou et al[34]	2007	53	TEND ± PCD ± PEG + irrigation	3	81.0	49.0	22.6	6.0	49% INP
Seifert et al[35]	2009	93	TEND	6	80.0	26.0	11.8	7.5	1999-2005
		(NS)
Raraty et al[36]	2010	137	VARD			75.0		19.0	64% INP
		(NS)
van Santvoort et al[15]	2010	43	Lt. RPD + N (Step-up)	1-7	35.0	40.0	60.0	19.0	RCT
		(NS)
Gardner et al[37]	2011	104	TEND	1-14	91.0	14.0	2.0	2.0	39% INP
Bausch et al[50]	2012	30	PCD + N		57.0	43.0	21.0	21.0	93% INP
		18	TEND		50.0	44.0	28.0	6.0	72% INP
Ross et al[10]	2014	117	TEND + PCD	NA	100.0	4.2	0.0	3.4	Dual modality
van Brunschot et al[38]	2014	455	TEN ± PCD	4 (1-23)	81.0	36.0	10.0	6.0	Systematic review; 57% INP
		(NS)

¹Values are mean or range. INP: Infected necrotizing pancreatitis; Lap: Laparotomy; N: Necrosectomy; NA: Not available; NS: Walled-off necrosis was not specified; PF: Pancreatic fistula; PCD: Percutaneous drainage; PEG-J: Percutaneous endoscopic gastrostomy-jejunal arm; RCT: Randomized control study; RPD: Retroperitonium percutaneous endoscopic gastrostomy; TEN: Transluminal endoscopic necrosectomy; TEND: Transluminal endoscopic necrosectomy with drainage; VARD: Video assisted retroperitoneal debridement; WON: Walled-off necrosis.