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World Journal of Surgical Oncology
Published in: World Journal of Surgical Oncology 1/2016

Open Access 01-12-2016 | Research

Efficacy of preoperative biliary drainage in malignant obstructive jaundice: a meta-analysis and systematic review

Authors: Harsha Moole, Matthew Bechtold, Srinivas R. Puli

Published in: World Journal of Surgical Oncology | Issue 1/2016

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Abstract

Background

In patients requiring surgical resection for malignant biliary jaundice, it is unclear if preoperative biliary drainage (PBD) would improve mortality and morbidity by restoration of biliary flow prior to operation. This is a meta-analysis to pool the evidence and assess the utility of PBD in patients with malignant obstructive jaundice. The primary outcome is comparing mortality outcomes in patients with malignant obstructive jaundice undergoing direct surgery (DS) versus PBD. The secondary outcomes include major adverse events and length of hospital stay in both the groups.

Methods

Studies using PBD in patients with malignant obstructive jaundice were included in this study. For the data collection and extraction, articles were searched in MEDLINE, PubMed, Embase, Cochrane Central Register of Controlled Trials & Database of Systematic Reviews, etc. Pooled proportions were calculated using both Mantel-Haenszel method (fixed effects model) and DerSimonian-Laird method (random effects model).

Results

Initial search identified 2230 reference articles, of which 204 were selected and reviewed. Twenty-six studies (N = 3532) for PBD in malignant obstructive jaundice which met the inclusion criteria were included in this analysis. The odds ratio for mortality in PBD group versus DS group was 0.96 (95 % CI = 0.71 to 1.29). Pooled number of major adverse effects was lower in the PBD group at 10.40 (95 % CI = 9.96 to 10.83) compared to 15.56 (95 % CI = 15.06 to 16.05) in the DS group. Subgroup analysis comparing internal PBD to DS group showed lower odds for major adverse events (odds ratio, 0.48 with 95 % CI = 0.32 to 0.74).

Conclusions

In patients with malignant biliary jaundice requiring surgery, PBD group had significantly less major adverse effects than DS group. Length of hospital stay and mortality rate were comparable in both the groups.
Literature
1.
Smith RA, Bosonnet L, Ghaneh P, et al. The platelet–lymphocyte ratio improves the predictive value of serum CA19-9 levels in determining patient selection for staging laparoscopy in suspected periampullary cancer. Surgery. 2008;143:658–66.CrossRefPubMed
2.
Michelassi F, Erroi F, Dawson PJ, et al. Experience with 647 consecutive tumors of the duodenum, ampulla, head of the pancreas, and distal common bile duct. Ann Surg. 1989;210:544–54.CrossRefPubMedPubMedCentral
3.
Engelken FJ, Bettschart V, Rahman MQ, Parks RW, Garden OJ. Prognostic factors in the palliation of pancreatic cancer. Eur J Surg Oncol. 2003;29:368–73.CrossRefPubMed
4.
Nehez L, Andersson R. Compromise of immune function in obstructive jaundice. Eur J Surg. 2002;168:315–28.CrossRefPubMed
5.
Pauli-Magnus C, Meier PJ. Hepatocellular transporters and cholestasis. J Clin Gastroenterol. 2005;39 Suppl 2:S103–10.CrossRefPubMed
6.
Wadei HM, Mai ML, Ahsan N, Gonwa TA. Hepatorenal syndrome: pathophysiology and management. Clin J Am Soc Nephrol. 2006;1:1066–79.CrossRefPubMed
7.
Papadopoulos V, Filippou D, Manolis E, Mimidis K. Haemostasis impairment in patients with obstructive jaundice. J Gastrointestin Liver Dis. 2007;16:177–86.PubMed
8.
Kawarada Y, Higashiguchi T, Yokoi H, et al. Preoperative biliary drainage in obstructive jaundice. Hepatogastroenterology. 1995;42:300–7.PubMed
9.
10.
Blamey SL, Fearon KC, Gilmour WH, et al. Prediction of risk in biliary surgery. Br J Surg. 1983;70:535–8.CrossRefPubMed
11.
Rougneen PT, Gouma DJ, Kulkarni AD, Fanslow WF, Rowlands BJ. Impaired specific cell immunity in experimental biliary obstruction and its reversibility by internal biliary drainage. J Surg Res. 1986;41:113e25.
12.
Gouma DJ, Coelho JCU, Fisher JD, Schlegel JF, Li YF, Moody FG. Endotoxaemia after relief of biliary obstruction by internal and external drainage in rats. Am J Surg. 1986;151:476e9.CrossRef
13.
Gouma DJ, Rougheen PT, Kumar S, Moody FG, Rowlands BJ. Changes in nutritional status associated with obstructive jaundice and biliary drainage in rats. Am J Clin Nutr. 1986;44:362e9.
14.
Greig JD, Krukowski ZH, Matheson NA. Surgical morbidity and mortality in one hundred and twenty-nine patients with obstructive jaundice. Br J Surg. 1988;75:216–9.CrossRefPubMed
15.
Armstrong CP, Dixon JM, Taylor TV, et al. Surgical experience of deeply jaundiced patients with bile duct obstruction. Br J Surg. 1984;71:234–8.CrossRefPubMed
16.
Whipple AO, Parsons WB, Miller CR. Treatment of carcinoma of the ampulla of Vater. Ann Surg. 1935;102:763e9.
17.
Fang Y, Gurusamy KS, Wang Q, et al. Meta-analysis of randomized clinical trials on safety and efficacy of biliary drainage before surgery for obstructive jaundice. Br J Surg. 2013;100(12):1589–96.CrossRefPubMed
18.
Sewnath ME, Karsten TM, Prins MH, et al. A meta-analysis on the efficacy of preoperative biliary drainage for tumors causing obstructive jaundice. Ann Surg. 2002;236(1):17–27.CrossRefPubMedPubMedCentral
19.
20.
Morris-Stiff G, Tamijmarane A, Tan YM, et al. Pre-operative stenting is associated with a higher prevalence of post-operative complications following pancreatoduodenectomy. Int J Surg. 2011;9(2):145–9.CrossRefPubMed
21.
van der Gaag NA, Rauws EA, van Eijck CH, et al. Preoperative biliary drainage for cancer of the head of the pancreas. N Engl J Med. 2010;362(2):129–37.CrossRefPubMed
22.
Coates JM, Beal SH, Russo JE, et al. Negligible effect of selective preoperative biliary drainage on perioperative resuscitation, morbidity, and mortality in patients undergoing pancreaticoduodenectomy. Arch Surg. 2009;144(9):841–7.CrossRefPubMed
23.
Anderson F, Clarke DL, Thomson SR. Preoperative biliary stenting—a prequel to pancreatic resection in selected patients. S Afr J Surg. 2004;42(4):128–30.PubMed
24.
Pisters PW, Hudec WA, Hess KR, et al. Effect of preoperative biliary decompression on pancreaticoduodenectomy-associated morbidity in 300 consecutive patients. Ann Surg. 2001;234(1):47–55.CrossRefPubMedPubMedCentral
25.
Sewnath ME, Birjmohun RS, Rauws EA, et al. The effect of preoperative biliary drainage on postoperative complications after pancreaticoduodenectomy. J Am Coll Surg. 2001;192(6):726–34.CrossRefPubMed
26.
Martignoni ME, Wagner M, Krähenbühl L, et al. Effect of preoperative biliary drainage on surgical outcome after pancreatoduodenectomy. Am J Surg. 2001;181(1):52–9. discussion 87.CrossRefPubMed
27.
Sohn TA, Yeo CJ, Cameron JL, Pitt HA, Lillemoe KD. Do preoperative biliary stents increase postpancreaticoduodenectomy complications? J Gastrointest Surg. 2000;4(3):258–67. discussion 267-8.CrossRefPubMed
28.
Figueras J, Llado L, Valls C, et al. Changing strategies in diagnosis and management of hilar cholangiocarcinoma. Liver Transpl. 2000;6(6):786–94.CrossRefPubMed
29.
Wig JD, Kumar H, Suri S, Gupta NM. Usefulness of percutaneous transhepatic biliary drainage in patients with surgical jaundice—a prospective randomised study. J Assoc Physicians India. 1999;47(3):271–4.PubMed
30.
Povoski SP, Karpeh Jr MS, Conlon KC, Blumgart LH, Brennan MF. Association of preoperative biliary drainage with postoperative outcome following pancreaticoduodenectomy. Ann Surg. 1999;230(2):131–42.CrossRefPubMedPubMedCentral
31.
Hochwald SN, Burke EC, Jarnagin WR, Fong Y, Blumgart LH. Association of preoperative biliary stenting with increased postoperative infectious complications in proximal cholangiocarcinoma. Arch Surg. 1999;134(3):261–6.CrossRefPubMed
32.
Heslin MJ, Brooks AD, Hochwald SN, et al. A preoperative biliary stent is associated with increased complications after pancreatoduodenectomy. Arch Surg. 1998;133(2):149–54.CrossRefPubMed
33.
Marcus SG, Dobryansky M, Shamamian P, et al. Endoscopic biliary drainage before pancreaticoduodenectomy for periampullary malignancies. J Clin Gastroenterol. 1998;26(2):125–9.CrossRefPubMed
34.
Karsten TM, Allema JH, Reinders M, et al. Preoperative biliary drainage, colonisation of bile and postoperative complications in patients with tumours of the pancreatic head: a retrospective analysis of 241 consecutive patients. Eur J Surg. 1996;162(11):881–8.PubMed
35.
Chou FF, Sheen-Chen SM, Chen YS, Chen MC, Chen CL. Postoperative morbidity and mortality of pancreaticoduodenectomy for periampullary cancer. Eur J Surg. 1996;162(6):477–81.PubMed
36.
Lai EC, Mok FP, Fan ST, et al. Preoperative endoscopic drainage for malignant obstructive jaundice. Br J Surg. 1994;81(8):1195–8.CrossRefPubMed
37.
Bakkevold KE, Kambestad B. Morbidity and mortality after radical and palliative pancreatic cancer surgery. Risk factors influencing the short-term results. Ann Surg. 1993;217(4):356–68.CrossRefPubMedPubMedCentral
38.
Sirinek KR, Levine BA. Percutaneous transhepatic cholangiography and biliary decompression. Invasive, diagnostic, and therapeutic procedures with too high a price? Arch Surg. 1989;124(8):885–8.CrossRefPubMed
39.
Lygidakis NJ, van der Heyde MN, Lubbers MJ. Evaluation of preoperative biliary drainage in the surgical management of pancreatic head carcinoma. Acta Chir Scand. 1987;153(11-12):665–8.PubMed
40.
Pitt HA, Gomes AS, Lois JF, et al. Does preoperative percutaneous biliary drainage reduce operative risk or increase hospital cost? Ann Surg. 1985;201(5):545–53.CrossRefPubMedPubMedCentral
41.
Smith RC, Pooley M, George CR, Faithful GR. Preoperative percutaneous transhepatic internal drainage in obstructive jaundice: a randomized, controlled trial examining renal function. Surgery. 1985;97(6):641–8.PubMed
42.
Gundry SR, Strodel WE, Knol JA, Eckhauser FE, Thompson NW. Efficacy of preoperative biliary tract decompression in patients with obstructive jaundice. Arch Surg. 1984;119(6):703–8.CrossRefPubMed
43.
McPherson GA, Benjamin IS, Hodgson HJ, et al. Pre-operative percutaneous transhepatic biliary drainage: the results of a controlled trial. Br J Surg. 1984;71(5):371–5.CrossRefPubMed
44.
Hatfield AR, Tobias R, Terblanche J, et al. Preoperative external biliary drainage in obstructive jaundice. A prospective controlled clinical trial. Lancet. 1982;2(8304):896–9.CrossRefPubMed
45.
Denning DA, Ellison EC, Carey LC. Preoperative percutaneous transhepatic biliary decompression lowers operative morbidity in patients with obstructive jaundice. Am J Surg. 1981;141(1):61–5.CrossRefPubMed
46.
47.
Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Controlled Clin Trials. 1996;17:1–12.CrossRefPubMed
48.
Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in Epidemiology (MOOSE) group. JAMA. 2000;283(15):2008–12.CrossRefPubMed
49.
Stuart A, Ord JK. Kendall’s advanced theory of statistics (6th edition). London: Edward Arnold; 1994.
50.
51.
Deeks JJ. Systematic reviews of evaluations of diagnostic and screening tests. In: Egger M, Smith GD, Altman DG, editors. Systematic reviews in health care. Meta-analysis in context. London: BMJ Books; 2001.
52.
Harbord RM, Egger M, Sterne JAC. A modified test for small-study effects in meta-analyses of controlled trials with binary endpoints. Stat Med. 2005;25(20):3443–57.CrossRef
53.
Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50:1088–101.CrossRefPubMed
54.
Sterne JAC, Egger M, Davey-Smith G. Investigating and dealing with publication and other biases in meta-analysis. Br Med J. 2001;323:101–5.CrossRef
55.
Sterne JAC, Egger M. Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis. J Clin Epidemiol. 2001;54:1046–55.CrossRefPubMed
56.
Koyama K, Takagi Y, Ito K, Sato T. Experimental and clinical studies on the effect of biliary drainage in obstructive jaundice. Am J Surg. 1981;142(2):293–9.CrossRefPubMed
57.
Aronson DC, Chamuleau RA, Frederiks WM, et al. Reversibility of cholestatic changes following experimental common bile duct obstruction: fact or fantasy? J Hepatol. 1993;18(1):85–95.CrossRefPubMed
58.
Hunt DR, Allison ME, Prentice CR, et al. Endotoxemia, disturbance of coagulation, and obstructive jaundice. Am J Surg. 1982;144(3):325–9.CrossRefPubMed
59.
Hunt CE, Diani AR, Brown PK, et al. Diet induced atherogenic hyperlipoproteinaemia and liver injury in cynomolgus macaques. Br J Exp Pathol. 1986;67(2):235–49.PubMedPubMedCentral
60.
Kozarek R. Role of preoperative palliation of jaundice in pancreatic cancer. J Hepatobiliary Pancreat Sci. 2013;20(6):567–72.CrossRefPubMed
61.
Moole H, Dhillon S, Volmar F, Cashman M, Bechtold M, Puli S. Mo1378 Is there a survival and morbidity benefit of covered over uncovered metal stents in malignant biliary strictures? A meta-analysis and systematic review. Gastrointest Endosc. 2015;5(81):AB399.CrossRef
62.
Moole H, Bechtold M, Puli S. Mo1037 Comparison of double layer stents and self-expandable metal stents for malignant biliary strictures: a meta-analysis and systematic review. Gastrointest Endosc. 2016;5(83):AB347.
63.
Moole H, Cashman M, Volmar F, Dhillon S, Bechtold M, Puli S. Su1601 Are covered metal stents better than uncovered metal stents for malignant biliary stricture? A meta-analysis and systematic review. Gastrointest Endosc. 2015;5(81):AB346.CrossRef
64.
Moole H, Puli S. Sa1408 Are metal stents better than plastic stents for malignant distal common bile duct stricture? A meta-analysis and systematic review. Gastrointest Endosc. 2015;5(81):AB202.CrossRef
65.
Moole H, Cashman M, Volmar F, Dhillon S, Bechtold M, Puli S. Sa1869 Is there a morbidity and survival benefit for metal over plastic stents in managing malignant distal biliary strictures? A meta-analysis and systematic review. Gastroenterology. 2015;148(4):S–1030.
66.
Moole H, Puli S. Tu1928 Complications of metal versus plastic stents in malignant distal biliary strictures: a meta-analysis and systematic review. Gastroenterology. 2015;148(4):S–937.
67.
Moole H, Puli S. Su1072 Comparison of complications for covered versus uncovered metal stents in malignant biliary strictures: a meta-analysis and systematic review. Gastroenterology. 2015;148(4):S–400.
Metadata
Title
Efficacy of preoperative biliary drainage in malignant obstructive jaundice: a meta-analysis and systematic review
Authors
Harsha Moole
Matthew Bechtold
Srinivas R. Puli
Publication date
01-12-2016
Publisher
BioMed Central
Published in
World Journal of Surgical Oncology / Issue 1/2016
Electronic ISSN: 1477-7819
DOI
https://doi.org/10.1186/s12957-016-0933-2

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