Preoperative Biliary Drainage For Pancreatic Head Carcinoma:a Systematic Review And Meta-analysis

Objective:The aim of this study is to carry out a meta-analysis and to systematically review the impact of preoperative biliary drainage in obstructive jaundiced patients for pancreatic head carcinoma compared with that of the direct early surgery group based on their clinical postoperative outcomes. These include the overall postoperative complications, overall infections, overall wound infections, the incidence of intra-abdominal abscess, overall mortality and the incidence of pancreatic fistula or bile leak.Methods:Systematic search of publications were conducted electronically (PubMed, Embase, Web of Science, the Cochrane library from 2000-2015). For the first search, text key words were "preoperative biliary drainage", "pancreatic cancer", and "obstructive jaundice". Studies included were Randomized controlled trials, Case-control studies and Cohort studies if they investigated and compared the preoperative biliary drainage outcomes with surgery outcomes in patients with obstructive jaundice caused by a tumor of the pancreatic head.Results:Based on inclusion criteria and exclusion criteria,10 studies were included in this study. Year published ranged from the year 2000 to this year 2015, and a total of 2113 patients. Among these patients 930 underwent preoperative biliary drainage procedure and 832 underwent direct early surgery. Early surgery group was compared with Preoperative Biliary Drainage group. There was no significant heterogeneity in the subgroup studies included except for one of the incidence of wound infection. Between the two compared groups, meta-analysis showed significant difference only in the incidence of intra-abdominal abscess in which six studies had reported results of the incidence (p=0.02) (RR=0.50,95%CI [0.29, 0.88]). No significant difference were found in overall postoperative complications (RR=0.89,95% CI [0.76,1.05]), overall infections (RR=0.57,95%CI [0.22,1.47]), overall mortality (RR=1.22,95%CI [0.95,157]), incidence of wound infection (RR=0.94,95%CI [0.41,2.16]) and the incidence of pancreatic fistula or bile leak (RR=1.21,95% CI [0.89,1.65]).Conclusions:Preoperative biliary drainage group when compared with direct early surgery group showed increased incidence of intra-abdominal abscess for pancreatic head carcinoma patients.