Comparison of Different Surgical Methods for Necrotizing Pancreatitis: A Meta-Analysis
Purpose: To compare the effectiveness and safety of three methods of open necrosectomy, minimally invasive surgery and endoscopic step-up approach for necrotizing pancreatitis.Methods: We searched Pubmed, Embase, ScienceDirect, and CNKI full text database (CNKI) (to December 25, 2019). RCT, prospect...
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doaj-467638086d514bf78cdeda508a7d8c4f2021-09-22T05:41:57ZengFrontiers Media S.A.Frontiers in Surgery2296-875X2021-09-01810.3389/fsurg.2021.723605723605Comparison of Different Surgical Methods for Necrotizing Pancreatitis: A Meta-AnalysisJianguo Xiao0Jianguo Xiao1Xiaojiao Quan2Fang Liu3Fang Liu4Wen Li5Medicinal School of Chinese People's Liberation Army, Beijing, ChinaDepartment of Critical Care Medicine, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, ChinaDepartment of Critical Care Medicine, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, ChinaMedicinal School of Chinese People's Liberation Army, Beijing, ChinaDepartment of Gastroenterology and Hepatology, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, ChinaDepartment of Gastroenterology and Hepatology, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, ChinaPurpose: To compare the effectiveness and safety of three methods of open necrosectomy, minimally invasive surgery and endoscopic step-up approach for necrotizing pancreatitis.Methods: We searched Pubmed, Embase, ScienceDirect, and CNKI full text database (CNKI) (to December 25, 2019). RCT, prospective cohort study (PCS), and retrospective cohort study (RCS) comparing the effectiveness and safety of any two of above-mentioned three methods were included.Results: There was no significant difference in major complications or death, and mortality between the minimally invasive surgery treatment group and the endoscopic step-up approach treatment group (RR = 1.66, 95%CI: 0.83–3.33, P = 0.15; RR = 1.05, 95%CI: 0.59–1.86, P = 0.87); the incidence rate of new-onset multiple organ failure, enterocutaneous fistula, pancreatic-cutaneous fistula, intra-abdominal bleeding, and endocrine pancreatic insufficiency in the endoscopic step-up approach treatment group was significantly lower than minimally invasive surgery group (RR = 2.65, 95%CI: 1.10–6.36, P = 0.03; RR = 6.63, 95%CI: 1.59–27.60, P = 0.009; RR = 7.73, 95%CI: 3.00–19.89, P < 0.0001; RR = 1.91, 95%CI: 1.13–3.24, P = 0.02; RR = 1.83, 95%CI: 1.9–3.16, P = 0.02); hospital stay in the endoscopic step-up approach group was significantly shorter than minimally invasive surgical treatment group (MD = 11.26, 95%CI: 5.46–17.05, P = 0.0001). The incidence of pancreatic-cutaneous fistula in the endoscopic escalation step therapy group was significantly lower than that in the open necrosectomy group (RR = 0.11, 95%CI: 0.02–0.58, P = 0.009).Conclusion: Compared with minimally invasive surgery and open necrosectomy, although endoscopic step-up approach cannot reduce the main complications or death and mortality of patients, it can significantly reduce the incidence of some serious complications, such as pancreatic-cutaneous fistula, enterocutaneous fistula, intra-abdominal bleeding, endocrine pancreatic insufficiency, and can significantly shorten the patient's hospital stay.https://www.frontiersin.org/articles/10.3389/fsurg.2021.723605/fullnecrotizing pancreatitisminimally invasive surgeryendoscopic step-up approachmeta-analysisopen necrosectomy |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Jianguo Xiao Jianguo Xiao Xiaojiao Quan Fang Liu Fang Liu Wen Li |
spellingShingle |
Jianguo Xiao Jianguo Xiao Xiaojiao Quan Fang Liu Fang Liu Wen Li Comparison of Different Surgical Methods for Necrotizing Pancreatitis: A Meta-Analysis Frontiers in Surgery necrotizing pancreatitis minimally invasive surgery endoscopic step-up approach meta-analysis open necrosectomy |
author_facet |
Jianguo Xiao Jianguo Xiao Xiaojiao Quan Fang Liu Fang Liu Wen Li |
author_sort |
Jianguo Xiao |
title |
Comparison of Different Surgical Methods for Necrotizing Pancreatitis: A Meta-Analysis |
title_short |
Comparison of Different Surgical Methods for Necrotizing Pancreatitis: A Meta-Analysis |
title_full |
Comparison of Different Surgical Methods for Necrotizing Pancreatitis: A Meta-Analysis |
title_fullStr |
Comparison of Different Surgical Methods for Necrotizing Pancreatitis: A Meta-Analysis |
title_full_unstemmed |
Comparison of Different Surgical Methods for Necrotizing Pancreatitis: A Meta-Analysis |
title_sort |
comparison of different surgical methods for necrotizing pancreatitis: a meta-analysis |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Surgery |
issn |
2296-875X |
publishDate |
2021-09-01 |
description |
Purpose: To compare the effectiveness and safety of three methods of open necrosectomy, minimally invasive surgery and endoscopic step-up approach for necrotizing pancreatitis.Methods: We searched Pubmed, Embase, ScienceDirect, and CNKI full text database (CNKI) (to December 25, 2019). RCT, prospective cohort study (PCS), and retrospective cohort study (RCS) comparing the effectiveness and safety of any two of above-mentioned three methods were included.Results: There was no significant difference in major complications or death, and mortality between the minimally invasive surgery treatment group and the endoscopic step-up approach treatment group (RR = 1.66, 95%CI: 0.83–3.33, P = 0.15; RR = 1.05, 95%CI: 0.59–1.86, P = 0.87); the incidence rate of new-onset multiple organ failure, enterocutaneous fistula, pancreatic-cutaneous fistula, intra-abdominal bleeding, and endocrine pancreatic insufficiency in the endoscopic step-up approach treatment group was significantly lower than minimally invasive surgery group (RR = 2.65, 95%CI: 1.10–6.36, P = 0.03; RR = 6.63, 95%CI: 1.59–27.60, P = 0.009; RR = 7.73, 95%CI: 3.00–19.89, P < 0.0001; RR = 1.91, 95%CI: 1.13–3.24, P = 0.02; RR = 1.83, 95%CI: 1.9–3.16, P = 0.02); hospital stay in the endoscopic step-up approach group was significantly shorter than minimally invasive surgical treatment group (MD = 11.26, 95%CI: 5.46–17.05, P = 0.0001). The incidence of pancreatic-cutaneous fistula in the endoscopic escalation step therapy group was significantly lower than that in the open necrosectomy group (RR = 0.11, 95%CI: 0.02–0.58, P = 0.009).Conclusion: Compared with minimally invasive surgery and open necrosectomy, although endoscopic step-up approach cannot reduce the main complications or death and mortality of patients, it can significantly reduce the incidence of some serious complications, such as pancreatic-cutaneous fistula, enterocutaneous fistula, intra-abdominal bleeding, endocrine pancreatic insufficiency, and can significantly shorten the patient's hospital stay. |
topic |
necrotizing pancreatitis minimally invasive surgery endoscopic step-up approach meta-analysis open necrosectomy |
url |
https://www.frontiersin.org/articles/10.3389/fsurg.2021.723605/full |
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