Meta-analysis Of Endoscopic Versus Laparoscopic Treatment For Pancreatic Pseudocysts

Objective:This meta-analysis was conducted to explore the efficacy and safety of endoscopic and laparoscopic treatment of pancreatic pseudocyst(PPC),and to systematically evaluate the short-term and long-term success rate,complication rate,recurrence rate,operative time and postoperative hospital stay,in order to provide certain basis for clinicians to select minimally invasive treatment strategies for PPC.Method:By searching Pubmed,Embase,Cochrone Library,Chinese Biomedical Literature(CBM),WANFANG,CNKI and VIP database by computer,literature related to endoscopic versus laparoscopic treatment of pancreatic pseudocyst was collected.When searching,subject terms and their related free words are used for retrieval,and the retrieval time is until November 2022 in the self-established database.According to the inclusion and exclusion indicators,two researchers independently screened the literature and extracted the data.In case of any disagreement,the two parties negotiated or the third researcher with more experience decided.The Newcastle-Ottawa scale(NOS)was used to evaluate the literature quality of the included cohort studies.Statistical analysis of data was performed using Revman 5.3.3 and Stata 12.0 software,and parallel heterogeneity test was conducted.When significant heterogeneity existed,further analysis of the causes and sources of heterogeneity was required,and sensitivity analysis was conducted.Publication bias was assessed by Begg test and Egger test.Results:Seven studies,including one prospective study and six retrospective cohort studies,were included based on inclusion and exclusion criteria.The literature was published from 2008 to 2017 and included 331 patients.The results showed that the short-term success rate(OR=0.39,95%CI:0.05～3.08,P=0.37),long-term success rate(OR=0.87,95%CI:0.39～1.90,P=0.72)and complication rate(OR=0.94,95%CI:0.47～1.89,P=0.87),recurrence rate(OR=0.68,95%CI:0.28～1.64,P=0.39)had no difference.Long-term success rates were 50.0% to 100% in the endoscopic group and 78.9% to 100% in the laparoscopic group.Complication rates ranged from 0%to 25.0 % in the endoscopic group and 8.3 % to 26.3 % in the laparoscopic group.However,the operation time(MD=-64.53,95%CI:-69.43～-59.62,P<0.00001)and postoperative hospital stay(MD=-2.56,95%CI:-4.41～-0.71,P=0.007)in the endoscopic group were significantly shorter than those in the laparoscopic group,and the difference was statistically significant.The Begg test and Egger test results showed that there was no publication bias in the study(P>0.05).Conclusions:Endoscopic interventional treatment of pancreatic pseudocyst is safe and effective,and endoscopic drainage may be preferred over laparoscopic surgery for patients with PPC.1.The operation time of endoscopic treatment of pancreatic pseudocyst is shorter than that of laparoscopy.2.The hospital stay after endoscopy is shorter than that of laparoscopy.3.There is no difference in the success rate,complication rate and recurrence rate of pancreatic pseudocyst between endoscopic and laparoscopic surgery.