Comparison of early and late drainage interventions in necrotizing pancreatitis: a systematic review and meta-analysis

OBJECTIVE: This study was designed to evaluate differences in mortality, complication rates, and length of hospital stay between early (≤ 4 weeks) and delayed (> 4 weeks) minimally invasive drainage in patients with necrotizing pancreatitis (NP) through the synthesis of existing evidence. METHODS: Databases including PubMed, Embase, and the Cochrane Library were searched up to November 1, 2025. Eligible randomized controlled trials (RCTs) and cohort studies were included. Literature screening and data extraction were conducted in accordance with the PRISMA guidelines, and a random-effects model was employed for meta-analysis. RESULTS: A total of 11 studies involving 1,697 patients were included. Meta-analysis results demonstrated that the mortality rate in the early drainage intervention group was significantly higher than that in the delayed drainage intervention group (RR = 1.38; 95%CI 1.05-1.81; P = 0.02), though the stability of this finding was poor. The proportion of patients requiring subsequent further debridement was significantly higher in the early drainage intervention group compared with the delayed drainage intervention group (RR = 2.05; 95%CI 1.26-3.31; P = 0.004). No significant differences were detected between the two groups in terms of length of hospital stay (P = 0.17), length of intensive care unit (ICU) stay (P = 0.25), or the incidence of complications (P > 0.05). CONCLUSION: This meta-analysis supports prioritizing delayed drainage in the treatment of NP, as it reduces the need for subsequent invasive debridement procedures; however, early drainage may still hold significant value patients with infection or organ failure.