Preoperative Biliary Drainage Before Resection for Hilar Cholangiocarcinoma: Whether or Not? A Systematic Review
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The value of preoperative biliary drainage (PBD) before resection for hilar cholangiocarcinoma (HCCA) is still controversial nowadays. The objective of this review is to summarize quantitatively the evidence related to this issue.
Two investigators independently searched the Medline, Embase, Academic Search Premier (EBSCO), Chinese BioMedical Literature on disc (CBMdisc), and Chinese Medical Current Contents (CMCC) databases. Eleven studies with a total number of 711 HCCA cases were included. Comparison was made of PBD versus no PBD in HCCA patients undergoing surgical resection. Outcome measures were postoperative complications, in-hospital death rate, postoperative infectious complications, and postoperative hospital stay.
There was no difference in death rate or postoperative hospital stay between the two treatment modalities. However, the overall postoperative complication rate and postoperative infectious complication rate were significantly adversely affected by PBD compared with surgery without PBD. In postoperative complications analysis, ten studies including 442 patients who underwent PBD and 233 patients who had no PBD were estimated. The odds ratio (OR) for postoperative morbidity was 1.67: 95% confidence interval (CI) [1.17, 2.39]. In postoperative mortality analysis, ten studies including 422 patients who underwent PBD and 238 patients who had no PBD were estimated. The OR for postoperative mortality was 0.70: 95% CI [0.41, 1.19]. In postoperative infectious complications analysis, five studies including 134 patients who underwent PBD and 122 patients who had no PBD were estimated. The OR for infectious morbidity was 2.17: 95% CI [1.24, 3.80]. In postoperative hospital stay analysis, only three studies with 84 patients who underwent PBD and 65 patients who had no PBD were estimated; the weighted mean difference (WMD) for postoperative hospital stay was 5.37 days: 95% CI [−1.78, 12.52 days].
This systematic review could not provide evidence for a clinical benefit of using PBD in jaundiced patients with HCCA planned for surgery. Preoperative drainage should not routinely be performed in patients with proximal bile duct cancer scheduled for surgical resection. Because of the lack of uniformity of this analysis, randomized controlled trials (RCTs) with large sample size and improved PBD techniques should be carried out to confirm our results.
KeywordsHilar cholangiocarcinoma Preoperative biliary drainage Morbidity Mortality Hepatectomy Systematic review
Conflict of interest statement
- 19.Wang Q, Gurusamy KS, Lin H, et al. Preoperative biliary drainage for obstructive jaundice. Cochrane Database Syst Rev. 2008;CD005444. This recent Cochrane review provides a useful analysis of the available randomized data on preoperative biliary drainage, although it cannot reach definitive conclusions on the issue.Google Scholar
- 20.Mumtaz K, Hamid S, Jafri W. Endoscopic retrograde cholangiopancreaticography with or without stenting in patients with pancreaticobiliary malignancy, prior to surgery. Cochrane Database Syst Rev. 2007;CD006001. This recent Cochrane review provides a useful analysis of the available randomized data on preoperative biliary drainage, although it cannot reach definitive conclusions on the issue.Google Scholar
- 32.Parks RW, Currie EJ, Madhavan KK, et al. Increased bacterobilia associated with preoperative biliary drainage in patients with hilarcholangiocarcinoma. HPB. 2000;2:375–381.Google Scholar
- 37.Chen D, Peng BG, Li SQ, et al. Effect of preoperative biliary drainage on hilar cholangiocarcinoma in patients underwent resection operation. Zhongguo Shi Yong Wai Ke Za Zhi. 2007;27:805–808.Google Scholar
- 39.Ercolani G, Zanello M, Grazi GL, et al. Changes in the surgical approach to hilar cholangiocarcinoma during an 18-year period in a Western single center. J Hepatobiliary Pancreat Sci. 2010;1–9.Google Scholar
- 40.Takada T, Yasuda H. Value of pre-operative biliary drainage prior to bile duct cancer surgery: results of a retrospective review. Asian J Surg. 1996;19:84–87.Google Scholar
- 42.Patel T. Cholangiocarcinoma. Gastroenterol Hepatol. 2006;3:33–42.Google Scholar
- 44.Belghiti J, Ogata S. Preoperative optimization of the liver for resection in patients with hilar cholangiocarcinoma. HPB (Oxford). 2005;7:252–253.Google Scholar
- 52.Makuuchi M, Takayasu K, Takuma T, et al. Preoperative transcatheter embolization of the portal venous branch for patients receiving extended lobectomy due to the bile duct carcinoma. J Jpn Soc Clin Surg. 1984;45:14–20.Google Scholar