Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Digestive Diseases and Sciences
Published in: Digestive Diseases and Sciences 3/2011

01-03-2011 | Review

Preoperative Biliary Drainage Before Resection for Hilar Cholangiocarcinoma: Whether or Not? A Systematic Review

Authors: Fei Liu, Ya Li, Yonggang Wei, Bo Li

Published in: Digestive Diseases and Sciences | Issue 3/2011

Login to get access

Abstract

Background

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.

Methods

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.

Results

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].

Conclusions

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.
Literature
1.
Klatskin G. Adenocarcinoma of the hepatic duct at its bifurcation within the porta hepatis: an unusual tumor with distinctive clinical and pathological features. Am J Med. 1965;38:241–256.CrossRefPubMed
2.
Dixon JM, Armstrong CP, Duffy SW, Davies GC. Factors affecting morbidity and mortality after surgery for obstructive jaundice: a review of 373 patients. Gut. 1983;24:845–852.CrossRefPubMed
3.
Blamey SL, Fearon KC, Gilmour WH, Osborne DH, Carter DC. Prediction of risk in biliary surgery. Br J Surg. 1983;70:535–538.CrossRefPubMed
4.
Shigeta H, Nagino M, Kamiya J, et al. Bacteremia after hepatectomy: an analysis of a single-center, 10-year experience with 407 patients. Langenbecks Arch Surg. 2002;387:117–124.CrossRefPubMed
5.
Lai EC, Chu KM, Lo CY, et al. Surgery for malignant obstructive jaundice: analysis of mortality. Surgery. 1992;112:891–896.PubMed
6.
Su CH, P’eng FK, Lui WY. Factors affecting morbidity and mortality in biliary tract surgery. World J Surg. 1992;16:536–540.CrossRefPubMed
7.
Nagino M, Nimura Y, Kamiya J, et al. Preoperative management of hilar cholangiocarcinoma. J Hepatobil Pancreat Surg. 1995;2:215–223.CrossRef
8.
Neuhaus P, Jonas S, Bechstein WO, et al. Extended resections for hilar cholangiocarcinoma. Ann Surg. 1999;230:808–818.CrossRefPubMed
9.
Nagino M, Kamiya J, Arai T, Nishio H, Ebata T, Nimura Y. “Anatomic” right hepatic trisectionectomy (extended right hepatectomy) with caudate lobectomy for hilar cholangiocarcinoma. Ann Surg. 2006;243:28–32.CrossRefPubMed
10.
Miyagawa S, Makuuchi M, Kawasaki S. Outcome of extended right hepatectomy after biliary drainage in hilar bile duct cancer. Arch Surg. 1995;130:759–763.PubMed
11.
Takada T, Hanyu F, Kobayashi S, et al. Percutaneous transhepatic cholangial drainage: direct approach under fluoroscopic control. J Surg Oncol. 1976;8:83–97.CrossRefPubMed
12.
Nakayama T, Ikeda A, Okuda K. Percutaneous transhepatic drainage of the biliary tract: technique and results in 104 cases. Gastroenterology. 1978;74:554–559.PubMed
13.
Hatfield AR, Tobias R, Terblanche J, et al. Preoperative external biliary drainage in obstructive jaundice. A prospective controlled clinical trial. Lancet. 1982;2:896–899.CrossRefPubMed
14.
Lai EC, Mok FP, Fan ST, et al. Preoperative endoscopic drainage for malignant obstructive jaundice. Br J Surg. 1994;81:1195–1198.CrossRefPubMed
15.
McPherson GA, Benjamin IS, Hodgson HJ, et al. Preoperative percutaneous transhepatic biliary drainage: the results of a controlled trial. Br J Surg. 1984;71:371–375.CrossRefPubMed
16.
Pitt HA, Gomes AS, Lois JF, et al. Does preoperative percutaneous biliary drainage reduce operative risk or increase hospital cost? Ann Surg. 1985;201:545–553.CrossRefPubMed
17.
Smith RC, Pooley M, George CR, et al. Preoperative percutaneous transhepatic internal drainage in obstructive jaundice: a randomized, controlled trial examining renal function. Surgery. 1985;97:641–648.PubMed
18.
Sewnath ME, Karsten TM, Prins MH, Rauws EJ, Obertop H, Gouma DJ. A meta-analysis on the efficacy of preoperative biliary drainage for tumors causing obstructive jaundice. Ann Surg. 2002;236:17–27.CrossRefPubMed
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.
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.
21.
Saleh MM, Norregaard P, Jorgensen HL, et al. Preoperative endoscopic stent placement before pancreaticoduodenectomy: a meta-analysis of the effect on morbidity and mortality. Gastrointest Endosc. 2002;56:529–534.CrossRefPubMed
22.
Kosuge T, Yamamoto J, Shimada K, et al. Improved surgical results for hilar cholangiocarcinoma with procedures including major hepatic resection. Ann Surg. 1999;230:663–671.CrossRefPubMed
23.
Burke EC, Jarnagin WR, Hochwald SN, et al. Hilar cholangiocarcinoma: patterns of spread, the importance of hepatic resection for curative operation, and a presurgical clinical staging system. Ann Surg. 1998;228(3):385–394.CrossRefPubMed
24.
Seyama Y, Kubota K, Sano K, et al. Long-term outcome of extended hemihepatectomy for hilar bile duct cancer with no mortality and high survival rate. Ann Surg. 2003;238:73–83.CrossRefPubMed
25.
Hochwald SN, Burke EC, Jarnagin WR, et al. Association of preoperative biliary stenting with increased postoperative infectious complications in proximal cholangiocarcinoma. Arch Surg. 1999;134:261–266.CrossRefPubMed
26.
Cherqui D, Benoist S, Malassagne B, et al. Major liver resection for carcinoma in jaundiced patients without preoperative biliary drainage. Arch Surg. 2000;135:302–308.CrossRefPubMed
27.
Nimura Y, Kamiya J, Kondo S, et al. Aggressive preoperative management and extended surgery for hilar cholangiocarcinoma: Nagoya experience. J Hepatobiliary Pancreat Surg. 2000;7:155–162.CrossRefPubMed
28.
Kawasaki S, Imamura H, Kobayashi A, et al. Results of surgical resection for patients with hilar bile duct cancer: application of extended hepatectomy after biliary drainage and hemihepatic portal vein embolization. Ann Surg. 2003;238:84–92.CrossRefPubMed
29.
Nagino M, Kamiya J, Nishio H, et al. Two hundred forty consecutive portal vein embolizations before extended hepatectomy for biliary cancer: surgical outcome and long-term follow-up. Ann Surg. 2006;243:364–372.CrossRefPubMed
30.
Zhou Y, Li N, Zhuang W, et al. Glutathione S-transferase P1 gene polymorphism associated with gastric cancer among Caucasians. Eur J Cancer. 2009;45:1438–1442.CrossRefPubMed
31.
Figueras J, Llado L, Valls C, et al. Changing strategies in diagnosis and management of hilar cholangiocarcinoma. Liver Transpl. 2000;6:786–794.PubMed
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.
33.
Su CH, Tsay SH, Wu CC, et al. Factors influencing postoperative morbidity, mortality, and survival after resection for hilar cholangiocarcinoma. Ann Surg. 1996;223:384–394.CrossRefPubMed
34.
Li SQ, Chen D, Liang LJ, et al. The impact of preoperative biliary drainage on surgical morbidity in hilar cholangiocarcinoma patients. Zhonghua Wai Ke Za Zhi. 2009;47:1134–1137.PubMed
35.
Ferrero A, Lo Tesoriere R, Viganò L, et al. Preoperative biliary drainage increases infectious complications after hepatectomy for proximal bile duct tumor obstruction. World J Surg. 2009;33:318–325.CrossRefPubMed
36.
Gerhards MF, van Gulik TM, de Wit LT, et al. Evaluation of morbidity and mortality after resection for hilar cholangiocarcinoma—a single center experience. Surgery. 2000;127:395–404.CrossRefPubMed
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.
38.
Dinant S, Gerhards MF, Rauws EA, et al. Improved outcome of resection of hilar cholangiocarcinoma (Klatskin tumor). Ann Surg Oncol. 2006;13:872–880.CrossRefPubMed
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.
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.
41.
Malhi H, Gores J. Review article: the modern diagnosis and therapy of cholangiocarcinoma. Aliment Pharmacol Ther. 2006;23:1287–1296.CrossRefPubMed
42.
Patel T. Cholangiocarcinoma. Gastroenterol Hepatol. 2006;3:33–42.
43.
Khan SA, Davidson BR, Goldin R, et al. Guidelines for the diagnosis and treatment of cholangiocarcinoma: consensus document. Gut. 2002;51(Suppl 6):vi1–vi9.CrossRefPubMed
44.
Belghiti J, Ogata S. Preoperative optimization of the liver for resection in patients with hilar cholangiocarcinoma. HPB (Oxford). 2005;7:252–253.
45.
Gouma DJ, Coelho JC, Schlegel JF, et al. The effect of preoperative internal and external biliary drainage on mortality of jaundiced rats. Arch Surg. 1987;122:731–734.PubMed
46.
Saiki S, Chijiiwa K, Komura M, et al. Preoperative internal biliary drainage is superior to external biliary drainage in liver regeneration and function after hepatectomy in obstructive jaundiced rats. Ann Surg. 1999;230:655–662.CrossRefPubMed
47.
Vauthey JN, Blumgart LH. Recent advances in the management of cholangiocarcinomas. Semin Liver Dis. 1994;14:109–114.CrossRefPubMed
48.
Clements WD, Diamond T, McCrory DC, et al. Biliary drainage in obstructive jaundice: experimental and clinical aspects. Br J Surg. 1993;80:834–842.CrossRefPubMed
49.
Lee SG, Lee YJ, Park KM, et al. One hundred and eleven liver resections for hilar bile duct cancer. J Hepatobil Pancreat Surg. 2000;7:135–141.CrossRef
50.
Hemming AW, Reed AI, Fujita S, et al. Surgical management of hilar cholangiocarcinoma. Ann Surg. 2005;241:693–702.CrossRefPubMed
51.
Sano T, Shimada K, Sakamoto Y, et al. One hundred and two consecutive hepatobiliary resections for perihilar cholangiocarcinoma with zero mortality. Ann Surg. 2006;244:240–247.CrossRefPubMed
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.
53.
Mizuno S, Nimura Y, Suzuki H, et al. Portal vein branch occlusion induces cell proliferation of cholestatic rat liver. J Surg Res. 1996;60:249–257.CrossRefPubMed
54.
Kanai M, Tanaka M, Nimura Y, et al. Mitochondrial dysfunction in the non-obstructed lobe of rat liver after selective biliary obstruction. Hepatogastroenterology. 1992;39:385–391.PubMed
55.
Kamiya S, Nagino M, Kanazawa H, et al. The value of bile replacement during external biliary drainage: an analysis of intestinal permeability, integrity, and microflora. Ann Surg. 2004;239:510–517.CrossRefPubMed
56.
Kanazawa H, Nagino M, Kamiya S, et al. Synbiotics reduce postoperative infectious complications: a randomized controlled trial in biliary cancer patients undergoing hepatectomy. Langenbecks Arch Surg. 2005;390:104–113.CrossRefPubMed
57.
Sugawara G, Nagino M, Nishio H, et al. Perioperative synbiotic treatment to prevent postoperative infectious complications in biliary cancer surgery: a randomized controlled trial. Ann Surg. 2006;244:706–714.CrossRefPubMed
58.
Cahill CJ. Prevention of postoperative renal failure in patients with obstructive jaundice—the role of bile salts. Br J Surg. 1983;70:590–595.CrossRefPubMed
59.
Blenkharn JI, McPherson GA, Blumgart LH. An improved system for external biliary drainage. Lancet. 1981;2:781–782.CrossRefPubMed
60.
Karsten TM, Coene PP, van Gulik TM, et al. Morphologic changes of extrahepatic bile ducts during obstruction and subsequent decompression by endoprosthesis. Surgery. 1992;111:562–568.PubMed
61.
Kloek JJ, van der Gaag NA, Aziz Y, et al. Endoscopic and percutaneous preoperative biliary drainage in patients with suspected hilar cholangiocarcinoma. J Gastrointest Surg. 2010;14:119–125.CrossRefPubMed
62.
Bismuth H, Nakache R, Diamond T. Management strategies in resection for hilar cholangiocarcinoma. Ann Surg. 1992;215:31–38.CrossRefPubMed
63.
Nimura Y, Hayakawa N, Kamiya J, et al. Hepatic segmentectomy with caudate lobe resection for bile duct carcinoma of the hepatic hilus. World J Surg. 1990;14:535–544.CrossRefPubMed
64.
Gouma DJ, Roughneen PT, Kumar S, et al. Changes in nutritional status associated with obstructive jaundice and biliary drainage in rats. Am J Clin Nutr. 1986;44:362–369.PubMed
65.
Saitoh N, Hiraoka T, Uchino R, et al. Endotoxemia and intestinal mucosal dysfunction after the relief of obstructive jaundice by internal and external drainage in rats. Eur Surg Res. 1995;27:11–18.CrossRefPubMed
66.
Sewnath ME, Levels JHM, Oude Elferink RP, et al. Endotoxininduced mortality in bile duct-ligated rats after administration of reconstituted high-density lipoprotein. Hepatology. 2000;32:1289–1299.CrossRefPubMed
67.
Clements WD, McCaigue M, Erwin P, et al. Biliary decompression promotes Kupffer cell recovery in obstructive jaundice. Gut. 1996;38:925–931.CrossRefPubMed
68.
Koyama K, Takagi Y, Ito K, et al. Experimental and clinical studies on the effect of biliary drainage in obstructive jaundice. Am J Surg. 1981;142:293–299.CrossRefPubMed
Metadata
Title
Preoperative Biliary Drainage Before Resection for Hilar Cholangiocarcinoma: Whether or Not? A Systematic Review
Authors
Fei Liu
Ya Li
Yonggang Wei
Bo Li
Publication date
01-03-2011
Publisher
Springer US
Published in
Digestive Diseases and Sciences / Issue 3/2011
Print ISSN: 0163-2116
Electronic ISSN: 1573-2568
DOI
https://doi.org/10.1007/s10620-010-1338-7

Other articles of this Issue 3/2011

Digestive Diseases and Sciences 3/2011 Go to the issue

Editorial

Consensus Interferon: Tailored Therapy and the Impact of Adherence

Original Article

Computer-Assisted Analysis of Abrasive Transepithelial Brush Biopsies Increases the Effectiveness of Esophageal Screening: A Multicenter Prospective Clinical Trial by the EndoCDx Collaborative Group

Original Article

Women’s Health Training in Gastroenterology Fellowship: A National Survey of Fellows and Program Directors

Original Article

Immune Phenotype of Children with Newly Diagnosed and Gluten-Free Diet-Treated Celiac Disease

Original Article

Ileoscopy via Stoma After Diverting Ileostomy: A Safe and Effective Tool to Evaluate for Crohn’s Recurrence of Neoterminal Ileum

Editorial

Inflammation: An Equal-Opportunity Process
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits