Published online Jul 16, 2022. doi: 10.4253/wjge.v14.i7.443
Peer-review started: January 27, 2022
First decision: April 10, 2022
Revised: May 3, 2022
Accepted: June 20, 2022
Article in press: June 20, 2022
Published online: July 16, 2022
Treatment for severe acute pancreatitis (SAP) can significantly affect health related quality of life (HR-QoL). However, the effects of different treatment strategies such as surgical, minimally invasive or endoscopic necrosectomy, on HR-QoL remain poorly investigated. Therefore, there is no evidence to favor any of the existing approaches as the better treatment of SAP in terms of quality of life. To the best of our knowledge this is the first systematic review to assess HR-QoL following pancreatic necrosectomy in patients with SAP.
Traditionally, open necrosectomy has been the standard approach for patients with SAP and necrosis of pancreatic parenchyma. This was followed by the introduction of surgical step up-approach combined with minimally invasive necrosectomy as the treatment of choice. More recently, endoscopic necrosectomy has gained popularity as it offers significantly lower morbidity and mortality rates. However, in the era of patient-centered medicine, HR-QoL also needs to be considered. Unfortunately, there is no clear evidence to favor any of these procedures as the better treatment of SAP in terms of quality of life.
The objective of this study was to critically appraise the published evidence on HR-QoL in patients with SAP who underwent surgical or endoscopic necrosectomy.
A literature search was performed on several databases for studies that examined the HR-QOL following necrosectomy in adult patients with SAP. Studies published in English were excluded due to limited resources. Data were collected on the details of each study, patient characteristics as well as HR-QoL. The Cochrane risk of bias tool for randomized control trials (RoB 2.0) was used to assess bias in the included randomized studies whereas the Risk of Bias In Non-randomized Studies – of Interventions (ROBINS-I) was used to asses bias in the included observational studies.
Eleven studies evaluated HR-QoL following necrosectomy including 756 patients. Three studies were randomized trials and eight were cohort studies. One randomized trial and one cohort study demonstrated significantly improved physical scores at three months in patients who underwent endoscopic necrosectomy compared to surgical necrosectomy. In the only study that examined patients following endoscopic necrosectomy, the HR-QoL was also very good. Two randomized trials and one cohort study investigated the quality adjusted life years suggesting that endoscopic and surgical necrosectomy were comparable in cost effectiveness. When open necrosectomy was compared with minimally invasive approaches, patients who underwent the later reported better overall quality of life, vitality and mental health.
This study would suggest that the endoscopic approach should be the preferred method for pancreatic necrosectomy as it might offer better HR-QoL. However, more randomized trials powered to detect differences in HR-QoL are still required.
Future research should aim to provide the tools for a person-centered coordinated care through a patient reported experience and outcome measures. This will improve results, adherence, patient satisfaction and quality of life. It is also important to create a disease specific HR-QoL questionnaire for acute pancreatitis to allow evaluation of different management strategies and the impact they have on HR-QoL.