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Review
. 2018 Apr 19;8(1):47.
doi: 10.1186/s13613-018-0394-6.

The prognostic impact of abdominal surgery in cancer patients with neutropenic enterocolitis: a systematic review and meta-analysis, on behalf the Groupe de Recherche en Réanimation Respiratoire du patient d'Onco-Hématologie (GRRR-OH)

Colombe Saillard  1 , Lara Zafrani  2 , Michael Darmon  3   4 , Magali Bisbal  4   5 , Laurent Chow-Chine  5 , Antoine Sannini  5 , Jean-Paul Brun  5 , Jacques Ewald  6 , Olivier Turrini  6 , Marion Faucher  5 , Elie Azoulay  2   4   7 , Djamel Mokart  4   5
Affiliations
Review

The prognostic impact of abdominal surgery in cancer patients with neutropenic enterocolitis: a systematic review and meta-analysis, on behalf the Groupe de Recherche en Réanimation Respiratoire du patient d'Onco-Hématologie (GRRR-OH)

Colombe Saillard et al. Ann Intensive Care. .

Abstract

Neutropenic enterocolitis (NE) is a diagnostic and therapeutic challenge associated with high mortality rates, with controversial opinions on its optimal management. Physicians are usually reluctant to select surgery as the first-choice treatment, concerns being raised regarding the potential risks associated with abdominal surgery during neutropenia. Nevertheless, no published studies comforted this idea, literature is scarce and surgery has never been compared to medical treatment. This review and meta-analysis aimed to determine the prognostic impact of abdominal surgery on outcome of neutropenic cancer patients presenting with NE, versus medical conservative treatment. This meta-analysis included studies analyzing cancer patients presenting with NE, treated with surgical or medical treatment, searched by PubMed and Cochrane databases (1983-2016), according to PRISMA recommendations. The endpoint was hospital mortality. Fixed-effects models were used. The meta-analysis included 20 studies (385 patients). Overall estimated mortality was 42.2% (95% CI = 40.2-44.2). Abdominal surgery was associated with a favorable outcome with an OR of 0.41 (95% CI = 0.23-0.74; p = 0.003). Pre-defined subgroups analysis showed that neither period of admission, underlying malignancy nor neutropenia during the surgical procedure, influenced this result. Surgery was not associated with an excess risk of mortality compared to medical treatment. Defining the optimal indications of surgical treatment is needed.Trial registration PROSPERO CRD42016048952.

Keywords: Abdominal surgery; Cancer patients; Meta-analysis; Neutropenic enterocolitis; Typhlitis.

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Figures

Fig. 1
Fig. 1
Flowchart of selected studies, according to PRISMA recommendations
Fig. 2
Fig. 2
Funnel plot of included studies
Fig. 3
Fig. 3
Summary of odds ratio in included studies according to treatment arm (abdominal surgery versus medical conservative treatment)
Fig. 4
Fig. 4
Summary of odds ratio in included studies according to inclusion period
Fig. 5
Fig. 5
Summary of odds ratio in included studies according to underlying malignancy
Fig. 6
Fig. 6
Summary of odds ratio in included studies according to the presence of neutropenia the day of surgery
See this image and copyright information in PMC

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