Minimally invasive necrosectomy versus conventional surgery in the treatment of infected pancreatic necrosis: A systematic review and a meta-analysis of comparative studies

摘要

AIM: The purpose of this meta-analysis and systematic review is to compare minimally invasive necrosectomy (MIN) versus open necrosectomy (ON) surgery for infected necrosis of acute pancreatitis. METHODS: One randomized controlled trial and 3 clinical controlled trials were selected, with a total of 336 patients (215 patients who underwent MIN and 121 patients underwent ON) included after searching in the following databases: Medline, Embase, Cochrane Central Register of Controlled Trials, BioMed Central, Science Citation Index (from inception to August 2011), Greynet, SIGLE (System for Information on Grey Literature in Europe), National Technological Information Service, British Library Integrated catalogue, and the Current Controlled Trials. Statistical analysis is performed using the odds ratio (OR) and weighted mean difference with 95% confidence interval (CI). RESULTS: After the analysis of the data amenable to polling, significant advantages were found in favor of the MIN in terms of: incidence of multiple organ failure (OR, 0.16; 95% CI, 0.06-0.39) (P<0.0001), incisional hernias (OR, 0.23; 95% CI, 0.06-0.90) (P=0.03), new-onset diabetes (OR, 0.32; 95% CI, 0.12-0.88) (P=0.03), and for the use of pancreatic enzymes (OR, 0.005; 95% CI, 0.04-0.57) (P=0.005). No differences were found in terms of mortality rate (OR, 0.43; 95% CI, 0.18-1.05) (P=0.06), multiple systemic complications (OR, 0.34; 95% CI, 0.01-8.60) (P=0.51), surgical reintervention for further necrosectomy (OR, 0.16; 95% CI, 0.00-3.07) (P=0.19), intra-abdominal bleeding (OR, 0.79; 95% CI, 0.41-1.50) (P=0.46), enterocutaneous fistula or perforation of visceral organs (OR, 0.52; 95% CI, 0.27-1.00) (P=0.05), pancreatic fistula (OR, 0.66; 95% CI, 0.30-1.46) (P=0.30), and surgical reintervention for postoperative complications (OR, 0.50; 95% CI, 0.23-1.08) (P=0.08). CONCLUSIONS: The lack of comparative studies and high heterogeneity of the data present in the literature did not permit to draw a definitive conclusion on this topic. The results of the present meta-analysis might be helpful to design future high-powered randomized studies that compare MIN with ON for acute necrotizing pancreatitis.