The short-term and long-term clinical outcomes from early versus delayed minimally invasive intervention for acute necrotic collections in necrotizing pancreatitis: a systematic review and meta-analysis

Introduction: Evidence regarding the optimal timing of intervention for symptomatic acute necrotic collections (ANCs) in necrotizing pancreatitis remains inconsistent, particularly in the era of minimally invasive step-up approaches. This systematic review and meta-analysis (SR&MA) aimed to compare patient-centered clinical outcomes between early and delayed interventions. Methods: We searched five databases up to 31 January 2025, for clinical studies involving adult patients with ANCs comparing early minimally invasive interventions with delayed interventions. The primary outcome was overall mortality. Subgroup analyses were also performed. Results: This SR&MA included 18 studies (2 RCTs and 16 observational studies) comprising 2,392 patients with symptomatic ANCs requiring intervention. Pooled results demonstrated that early intervention was associated with increased overall mortality (OR 1.73, 95% CI 1.34 to 2.22, p < 0.001, I 2 = 4%; 18 studies), and a greater need for open surgery (OR 1.77, 95% CI 1.23 to 2.56, p = 0.002, I 2 = 39%; 11 studies) compared to delayed intervention. However, most studies were assessed to have a high risk of bias. No subgroup differences were found for the primary outcome. Conclusion: Early intervention for symptomatic ANCs was associated with higher overall mortality. Although limited by study quality, these findings suggest early intervention is a potential risk factor for adverse outcomes, warranting cautious clinical consideration.