Which strategy improves outcomes for patients with necrotizing pancreatitis—step-up or open necrosectomy? The PANTER trial compared a step-up approach, involving minimally invasive techniques, with traditional open necrosectomy for the management of infected pancreatic necrosis in patients with severe acute pancreatitis. This randomized controlled trial enrolled over 200 patients and found that the step-up approach, which involved drainage followed by necrosectomy if necessary, resulted in fewer complications, a shorter hospital stay, and similar or better survival rates compared to open surgery. The trial established that the step-up approach is a safer, more effective strategy for managing necrotizing pancreatitis, challenging the long-standing preference for open necrosectomy.