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The clinical outcome from early versus delayed minimally invasive intervention for infected pancreatic necrosis: a systematic review and meta-analysis

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Abstract

Background

While the management of infected pancreatic necrosis (IPN) has evolved in the last two decades with the adoption of minimally invasive interventions (drainage ± debridement), it is unknown whether the principle of delaying intervention inherited from the open surgery era still applies. The aim of the current study was to investigate the impact of the timing of minimally invasive intervention on the outcomes of patients with IPN requiring intervention.

Methods

PubMed, Embase, MEDLINE and Web of Science databases were searched for appropriate studies. The primary outcome of interest was hospital mortality, the secondary outcomes were the incidence of complications during the hospitalization, including new-onset organ failure, gastrointestinal fistula or perforation, bleeding and length of hospital or intensive care unit (ICU) stay.

Results

Seven clinical studies were included with a total of 742 patients with IPN requiring intervention, of whom 321 received early intervention and 421 delayed intervention. Results from the meta-analysis showed that early minimally invasive intervention did not increase hospital mortality (odds ratio 1.65, 95% confidence interval 0.97–2.81; p = 0.06) but was associated with a remarkably prolonged hospital stay and an increased incidence of gastrointestinal fistula or perforation when compared with delayed intervention.

Conclusions

Although no firm conclusion can be drawn because of the quality of available studies, it does appear that timing of intervention is a risk factor for adverse outcomes and ought to be investigated more rigorously in prospective studies.

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Acknowledgements

This work was supported by National Natural Science Foundation of China (No. 82070665) and Applied Basic Research Project of PLA (No. ALB19J002).

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Authors and Affiliations

  1. Center of Severe Acute Pancreatitis (CSAP), Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China

    Lin Gao, He Zhang, Gang Li, Bo Ye, Jing Zhou, Zhihui Tong, Lu Ke & Weiqin Li

  2. National Institute of Healthcare Data Science, Nanjing University, Nanjing, 210010, Jiangsu, China

    Lu Ke & Weiqin Li

  3. Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, School of Medicine, University of Auckland, Auckland, New Zealand

    John A. Windsor

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  1. Lin Gao
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  2. He Zhang
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  3. Gang Li
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  4. Bo Ye
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  5. Jing Zhou
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  6. Zhihui Tong
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  7. Lu Ke
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for the Chinese Acute Pancreatitis Clinical Trials Group (CAPCTG)

Contributions

LG acquisition of data; analysis and interpretation of data; drafting of the manuscript. HZ and GL acquisition of data; analysis and interpretation of data. BY and JZ material or technique support; critical revision of the manuscript. ZT critical revision of the manuscript; obtained funding. JW critical revision of the manuscript. LK and WL conceived, designed and supervised the study; analysis and interpretation of data; critical revision of the manuscript; obtained funding. All authors have read the manuscript and approved its submission.

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Correspondence to Lu Ke or Weiqin Li.

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Gao, L., Zhang, H., Li, G. et al. The clinical outcome from early versus delayed minimally invasive intervention for infected pancreatic necrosis: a systematic review and meta-analysis. J Gastroenterol 57, 397–406 (2022). https://doi.org/10.1007/s00535-022-01876-6

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  • DOI: https://doi.org/10.1007/s00535-022-01876-6

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