Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 28, 2015; 21(12): 3720-3730
Published online Mar 28, 2015. doi: 10.3748/wjg.v21.i12.3720
Effects of neutrophil elastase inhibitor in patients undergoing esophagectomy: A systematic review and meta-analysis
Zhi-Qiang Wang, Long-Qi Chen, Yong Yuan, Wen-Ping Wang, Zhong-Xi Niu, Yu-Shang Yang, Jie Cai
Zhi-Qiang Wang, Long-Qi Chen, Yong Yuan, Wen-Ping Wang, Zhong-Xi Niu, Yu-Shang Yang, Jie Cai, Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Wang ZQ and Chen LQ designed the research; Wang ZQ, Chen LQ, Yuan Y and Wang WP performed the research; Chen LQ, Niu ZX and Yang YS analyzed the data; Wang ZQ, Chen LQ and Cai J wrote the paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Long-Qi Chen, Professor, Department of Thoracic Surgery, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu 610041, Sichuan Province, China.
Telephone: +86-28-85421026 Fax: +86-28-85421026
Received: May 17, 2014
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.

Keywords: Neutrophil elastase inhibitor, Esophageal cancer, Esophagectomy, Systematic review, Meta-analysis

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.