Published online Mar 28, 2015. doi: 10.3748/wjg.v21.i12.3720
Peer-review started: May 17, 2014
First decision: June 10, 2014
Revised: June 23, 2014
Accepted: July 29, 2014
Article in press: July 30, 2014
Published online: March 28, 2015
AIM: To evaluate the benefit and safety of sivelestat (a neutrophil elastase inhibitor) administration in patients undergoing esophagectomy.
METHODS: Online databases including PubMed, EMBASE, the Cochrane Library, Web of Knowledge, and Chinese databases (Wanfang database, VIP and CNKI) were searched systematically up to November 2013. Randomized controlled trials and high-quality comparative studies were considered eligible for inclusion. Three reviewers evaluated the methodological quality of the included studies, and Stata 12.0 software was used to analyze the extracted data. The risk ratio (RR) was used to express the effect size of dichotomous outcomes, and mean difference (MD) or standardized mean difference was used to express the effect size of continuous outcomes.
RESULTS: Thirteen studies were included in this systematic review and nine studies were included in the meta-analysis. The duration of mechanical ventilation was significantly decreased in the sivelestat group on postoperative day 5 [I2 = 76.3%, SMD = -1.41, 95%CI: -2.63-(-0.19)]. Sivelestat greatly lowered the incidence of acute lung injury in patients after surgery (I2 = 0%, RR = 0.27, 95%CI: 0.08-0.93). However, it did not decrease the incidence of pneumonia, intensive care unit stay or postoperative hospital stay, and did not increase the incidence of complications such as anastomotic leakage, recurrent nerve palsy, wound infection, sepsis and catheter-related fever.
CONCLUSION: A neutrophil elastase inhibitor is beneficial in patients undergoing esophagectomy. More high quality, large sample, multi-center and randomized controlled trials are needed to validate this effect.
Core tip: Radical esophagectomy has been adopted in patients with esophageal carcinoma to improve survival. This technique is highly invasive, leading to excess surgical stress, a perioperative mortality of 3%-10%, and pulmonary disorders account for nearly 30%-60%. Sivelestat sodium hydrate, a specific neutrophil elastase inhibitor, actively protects patients with acute respiratory diseases. The efficacy and safety of sivelestat administered during esophagectomy has produced conflicting results and the conclusions from relevant studies are presented. This meta-analysis revealed that sivelestat is beneficial in patients undergoing esophagectomy, especially in terms of the duration of mechanical ventilation and the incidence of pulmonary complications.