We performed retrospective comparative (with prospectively acquired database) and prospective observational studies; data were collected from all consecutive patients with acute pancreatitis (n = 804), and those with IPN formed the study group. Patients with IPN were divided into 2 groups on the basis of diagnosis of IPN during 1997?002 (group 1, n = 30) or 2003?006 (group 2, n = 50). Eighteen patients in group 1 were treated by surgical necrosectomy, and 40 patients in group 2 were given primary conservative treatment; surgery was performed on patients if conservative treatment failed (n = 10). The primary outcome measure was mortality.
The mortality was comparable in group 1 versus group 2 (43 % vs 28 % ; P = .22). During a period of 10 years, the patients who received primary conservative treatment had significantly higher survival rates than those who received surgery (76.9 % vs 46.4 % ; P = .005). In the prospective study during 2007?008, the mortality from infected necrosis was 29.6 % after primary conservative treatment, confirming the results of the comparative study.
In treating patients with IPN, a primary conservative strategy resulted in mortality that was comparable with that after surgery, and 76 % of the patients were able to avoid surgery; 54.5 % of IPN patients were successfully managed with the primary conservative strategy.