Effect of preoperative biliary drainage on postoperative complications after pancreaticoduodenectomy: a Meta-analysis

doi:10.3877/cma.j.issn.2095-3232.2021.02.012

Abstract

Abstract:

Objective

To systematically evaluate the effect of preoperative biliary drainage (PBD) on the postoperative complications after pancreaticoduodenectomy (PD).

Methods

Literatures published between January 2009 to December 2019 were retrieved in PubMed, Web of Science, Embase, the Cochrane Library, Ovid Journals, CNKI, Wanfang Data and Chongqing VIP databases with the keywords of preoperative biliary drainage, obstructive jaundice, pancreaticoduodenectomy, pancreatic head cancer, periampullary malignancy, biliary stricture. Clinical data such as incidence of postoperative pancreatic fistula, bile leakage, delayed gastric emptying, operative area infection and abdominal infection of PBD and non-PBD groups (N-PBD group) were extracted and subjected to Meta-analysis.

Results

A total of 23 articles consisting of 6 537 patients were included. 3 479 cases were assigned in PBD group and 3 058 cases in N-PBD group. Meta-analysis showed that the incidence of pancreatic fistula in PBD group was 14.92%(505/3 385), significantly higher than 11.78%(359/2 964) in N-PBD group (OR=1.19, 95%CI:1.02-1.38, P=0.03). The incidence of delayed gastric emptying in PBD group was 13.40%(288/2 150), significantly higher than 11.72%(217/1 851) in N-PBD group (OR=1.25, 95%CI:1.03-1.52, P=0.02). The incidence of operative area infection in PBD group was 14.97%(480/3 207), significantly higher than 6.78%(189/2 789) in N-PBD group (OR=2.57, 95%CI:2.14-3.09, P<0.001). The incidence of bile leakage, abdominal infection, bleeding, cardiopulmonary complications, secondary operation and mortality did not significantly differ between two groups (P>0.05).

Conclusions

Routine PBD fails to bring significant benefits to patients with obstructive jaundice undergoing PD, whereas it increases the incidence of pancreatic fistula, delayed gastric emptying and operative area infection.

Key words: Pancreaticoduodenectomy, Drainage, Jaundice, obstructive, Postoperative complications, Meta-analysis

Qi Zeng, Apaer Shadike·, Jing Wu, Anweier Nuerzhatijiang·, Tao Li, Jinming Zhao, Tuxun Tuerhongjiang·. Effect of preoperative biliary drainage on postoperative complications after pancreaticoduodenectomy: a Meta-analysis[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2021, 10(02): 174-180.

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Figures/Tables 3

References 42

[1]	Kariya CM, Wach MM, Ruff SM, et al. Postbiliary drainage rates of cholangitis are impacted by procedural technique for patients with supra-ampullary cholangiocarcinoma: a SEER-medicare analysis[J]. J Surg Oncol, 2019, 120(2):249-255.
[2]	Pavlidis ET, Pavlidis TE. Pathophysiological consequences of obstructive jaundice and perioperative management[J]. Hepatobiliary Pancreat Dis Int, 2018, 17(1):17-21.
[3]	Sandini M, Honselmann KC, Birnbaum DJ, et al. Preoperative biliary stenting and major morbidity after pancreatoduodenectomy: does elapsed time matter?: the FRAGERITA study group[J]. Ann Surg, 2018, 268(5):808-814.
[4]	van der Gaag NA, Rauws EA, van Eijck CH, et al. Preoperative biliary drainage for cancer of the head of the pancreas[J]. N Engl J Med, 2010, 362(2):129-137.
[5]	Mezhir JJ, Brennan MF, Baser RE, et al. A matched case-control study of preoperative biliary drainage in patients with pancreatic adenocarcinoma: routine drainage is not justified[J]. J Gastrointest Surg, 2009, 13(12):2163-2169.
[6]	陈元岩，袁明，周东，等. 恶性梗阻性黄疸术前减黄78例临床分析[J]. 临床外科杂志2010，18(7)：449-450.
[7]	Morris-Stiff G, Tamijmarane A, Tan YM, et al. Pre-operative stenting is associated with a higher prevalence of post-operative complications following pancreatoduodenectomy[J]. Int J Surg, 2011, 9(2):145-149.
[8]	吕湖，肖玉芳. 术前胆道引流对胰十二指肠切除术术后的影响[J]. 湖南师范大学学报(医学版)，2011，8(2)：48-50.
[9]	王剑雄，孔棣. 术前减黄及相关因素对壶腹周围癌胰十二指肠切除术后并发症的影响[J]. 重庆医学，2011，40(32)：3302-3304.
[10]	冯健，黄志强，陈永亮，等. 术前梗阻性黄疸对胰十二指肠切除术后手术并发症及病死率的影响[J]. 中华外科杂志，2012，50(4)：294-298.
[11]	孙孝文，单毅. 术前胆道引流对低位恶性胆道梗阻患者行胰十二指肠切除术后的影响[J]. 国际消化病杂志，2012，32(2)：118-119，127.
[12]	段姚尧，周淑娟，郭双来. 术前减黄对低位胆道恶性梗阻性黄疸患者行胰十二指肠切除术的影响[J]. 武警医学院学报，2012，21(1)：18-20.
[13]	Singhirunnusorn J, Roger L, Chopin-Laly X, et al. Value of preoperative biliary drainage in a consecutive series of resectable periampullary lesions. from randomized studies to real medical practice[J]. Langenbecks Arch Surg, 2013, 398(2):295-302.
[14]	Cavell LK, Allen PJ, Vinoya C, et al. Biliary self-expandable metal stents do not adversely affect pancreaticoduodenectomy[J]. Am J Gastroenterol, 2013, 108(7):1168-1173.
[15]	王介营，李芹，王玉虎，等. 恶性梗阻性黄疸患者黄疸程度对胰十二指肠切除术后并发症的影响[J]. 疑难病杂志，2013，12(10)：773-775.
[16]	di Mola FF, Tavano F, Rago RR, et al. Influence of preoperative biliary drainage on surgical outcome after pancreaticoduodenectomy: single centre experience[J]. Langenbecks Arch Surg, 2014, 399(5): 649-657.
[17]	Arkadopoulos N, Kyriazi MA, Papanikolaou IS, et al. Preoperative biliary drainage of severely jaundiced patients increases morbidity of pancreaticoduodenectomy: results of a case-control study[J]. World J Surg, 2014, 38(11):2967-2972.
[18]	Liu C, Lu JW, Du ZQ, et al. Association of preoperative biliary drainage with postoperative morbidity after pancreaticoduodenectomy[J]. Gastroenterol Res Pract, 2015:796893.
[19]	Uemura K, Murakami Y, Satoi S, et al. Impact of preoperative biliary drainage on long-term survival in resected pancreatic ductal adenocarcinoma: a multicenter observational study[J]. Ann Surg Oncol, 2015, 22 Suppl 3:S1238-1246.
[20]	Sahora K, Morales-Oyarvide V, Ferrone C, et al. Preoperative biliary drainage does not increase major complications in pancreaticoduodenectomy: a large single center experience from the Massachusetts General Hospital[J]. J Hepatobiliary Pancreat Sci, 2016, 23(3):181-187.
[21]	El Nakeeb A, Salem A, Mahdy Y, et al. Value of preoperative biliary drainage on postoperative outcome after pancreaticoduodenectomy: a case-control study[J]. Asian J Surg, 2018, 41(2):155-162.
[22]	De Pastena M, Marchegiani G, Paiella S, et al. Impact of preoperative biliary drainage on postoperative outcome after pancreaticoduodenectomy: an analysis of 1500 consecutive cases[J]. Dig Endosc, 2018, 30(6):777-784.
[23]	周永平，魏倩，戴途，等. 术前内镜减黄对胰十二指肠切除术后并发症的影响[J]. 肝胆胰外科杂志，2018，30(2)：164-166.
[24]	许马川，谢伟，冯石坚，等. 低位恶性梗阻性黄疸行胰十二指肠切除术术前减黄的临床观察[J]. 中国当代医药，2018，25(15)：19-21，25.
[25]	李刚，毛谅，凡银银，等. 低位恶性梗阻性黄疸患者术前减黄临床疗效观察[J]. 肝胆外科杂志，2019，27(1)：27-30.
[26]	Endo Y, Noda H, Watanabe F, et al. Bridge of preoperative biliary drainage is a useful management for patients undergoing pancreaticoduodenectomy[J]. Pancreatology, 2019, 19(5):775-780.
[27]	Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition[J]. Surgery, 2005, 138(1):8-13.
[28]	Wente MN, Bassi C, Dervenis C, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS)[J]. Surgery, 2007, 142(5):761-768.
[29]	Kloek JJ, Heger M, van der Gaag NA, et al. Effect of preoperative biliary drainage on coagulation and fibrinolysis in severe obstructive cholestasis[J]. J Clin Gastroenterol, 2010, 44(9):646-652.
[30]	Kloek JJ, Marsman HA, van Vliet AK, et al. Biliary drainage attenuates postischemic reperfusion injury in the cholestatic rat liver[J]. Surgery, 2008, 144(1):22-31.
[31]	Zhang GQ, Li Y, Ren YP, et al. Outcomes of preoperative endoscopic nasobiliary drainage and endoscopic retrograde biliary drainage for malignant distal biliary obstruction prior to pancreaticoduodenectomy[J]. World J Gastroenterol, 2017, 23(29): 5386-5394.
[32]	Kurahara H, Maemura K, Mataki Y, et al. Preoperative biliary drainage-related inflammation is associated with shorter survival in biliary tract cancer patients[J]. Int J Clin Oncol, 2016, 21(5):934-939.
[33]	Chen Y, Ou G, Lian G, et al. Effect of preoperative biliary drainage on complications following pancreatoduodenectomy: a meta-analysis[J]. Medicine, 2015, 94(29):e1199.
[34]	Ngu W, Jones M, Neal CP, et al. Preoperative biliary drainage for distal biliary obstruction and post-operative infectious complications[J]. ANZ J Surg, 2013, 83(4):280-286.
[35]	Lermite E, Pessaux P, Teyssedou C, et al. Effect of preoperative endoscopic biliary drainage on infectious morbidity after pancreatoduodenectomy: a case-control study[J]. Am J Surg, 2008, 195(4):442-446.
[36]	Ahmetasevic E, Rifatbegovic Z, Ahmetasevic D, et al. Influence of preoperative endoscopic retrograde cholangiopancreatography (ERCP) on bacterial colonization of biliary tract in patients surgically treated for obstructive jaundice[J]. Mater Sociomed, 2019, 31(1):45-48.
[37]	Müssle B, Hempel S, Kahlert C, et al. Prognostic impact of bacterobilia on morbidity and postoperative management after pancreatoduodenectomy: a systematic review and meta-analysis[J]. World J Surg, 2018, 42(9):2951-2962.
[38]	Scheufele F, Schorn S, Demir IE, et al. Preoperative biliary stenting versus operation first in jaundiced patients due to malignant lesions in the pancreatic head: a meta-analysis of current literature[J]. Surgery, 2017, 161(4):939-950.
[39]	Togawa O, Isayama H, Kawakami H, et al. Preoperative biliary drainage using a fully covered self-expandable metallic stent for pancreatic head cancer: a prospective feasibility study[J]. Saudi J Gastroenterol, 2018, 24(3):151-156.
[40]	Tol JA, van Hooft JE, Timmer R, et al. Metal or plastic stents for preoperative biliary drainage in resectable pancreatic cancer[J]. Gut, 2016, 65(12):1981-1987.
[41]	Jeune F, Coriat R, Prat F, et al. Pancreatic cancer surgical management[J]. Presse Med, 2019, 48(3 Pt 2):e147-158.
[42]	Sauvanet A, Boher JM, Paye F, et al. Severe jaundice increases early severe morbidity and decreases long-term survival after pancreaticoduodenectomy for pancreatic adenocarcinoma[J]. J Am Coll Surg, 2015, 221(2):380-389.

作者	年份	国家	研究类型	样本量（例）		引流方式	NOS评分
作者	年份	国家	研究类型	PBD组	N-PBD组	引流方式	NOS评分
van der Gaag等^[4]	2010	英国	随机对照研究	102	94	ERCP/PTCD	低风险
Mezhir等^[5]	2009	美国	病例对照研究	94	94	ERCP/PTCD	7
陈元岩等^[6]	2010	中国	病例对照研究	24	54	PTCD	6
Morris-Stiff等^[7]	2011	英国	病例对照研究	118	162	ERCP/PTCD	6
吕湖等^[8]	2011	中国	病例对照研究	46	90	PTCD/ERBD/EMBE	6
王剑雄等^[9]	2011	中国	病例对照研究	33	30	PTCD/ENBD	6
冯健等^[10]	2012	中国	病例对照研究	133	239	PTCD/ERCP	7
孙孝文等^[11]	2012	中国	病例对照研究	19	52	PTCD/ERCP	7
段姚尧等^[12]	2012	中国	病例对照研究	40	34	PTCD	6
Singhirunnusorn等^[13]	2013	法国	病例对照研究	38	62	ERCP	7
Cavell等^[14]	2013	美国	病例对照研究	220	289	ERCP/ENBD	7
王介营等^[15]	2013	中国	病例对照研究	41	43	PTCD/ENBD	6
di Mola等^[16]	2014	德国	病例对照研究	53	40	ERCP/PTCD	7
Arkadopoulos等^[17]	2014	希腊	病例对照研究	76	76	ERCP	7
Liu等^[18]	2015	中国	病例对照研究	47	47	ERCP/PTCD/ENBD	6
Uemura等^[19]	2015	日本	病例对照研究	573	359	PTBD/ERCP	6
Sahora等^[20]	2016	日本	病例对照研究	500	500	ERCP	7
El Nakeeb等^[21]	2016	埃及	病例对照研究	314	274	PTCD/ENBD	7
De Pastena等^[22]	2018	意大利	病例对照研究	714	258	ERCP/PTBD	7
周永平等^[23]	2018	中国	病例对照研究	30	43	ERCP/ENBD	7
许马川等^[24]	2018	中国	病例对照研究	36	42	PTCD/ENBD/ERCP	6
李刚等^[25]	2019	中国	病例对照研究	49	63	ENBD	7
Endo等^[26]	2019	日本	病例对照研究	179	113	ENBD/ERBD	7

作者	年份	国家	研究类型	样本量（例）		引流方式	NOS评分
作者	年份	国家	研究类型	PBD组	N-PBD组	引流方式	NOS评分
van der Gaag等^[4]	2010	英国	随机对照研究	102	94	ERCP/PTCD	低风险
Mezhir等^[5]	2009	美国	病例对照研究	94	94	ERCP/PTCD	7
陈元岩等^[6]	2010	中国	病例对照研究	24	54	PTCD	6
Morris-Stiff等^[7]	2011	英国	病例对照研究	118	162	ERCP/PTCD	6
吕湖等^[8]	2011	中国	病例对照研究	46	90	PTCD/ERBD/EMBE	6
王剑雄等^[9]	2011	中国	病例对照研究	33	30	PTCD/ENBD	6
冯健等^[10]	2012	中国	病例对照研究	133	239	PTCD/ERCP	7
孙孝文等^[11]	2012	中国	病例对照研究	19	52	PTCD/ERCP	7
段姚尧等^[12]	2012	中国	病例对照研究	40	34	PTCD	6
Singhirunnusorn等^[13]	2013	法国	病例对照研究	38	62	ERCP	7
Cavell等^[14]	2013	美国	病例对照研究	220	289	ERCP/ENBD	7
王介营等^[15]	2013	中国	病例对照研究	41	43	PTCD/ENBD	6
di Mola等^[16]	2014	德国	病例对照研究	53	40	ERCP/PTCD	7
Arkadopoulos等^[17]	2014	希腊	病例对照研究	76	76	ERCP	7
Liu等^[18]	2015	中国	病例对照研究	47	47	ERCP/PTCD/ENBD	6
Uemura等^[19]	2015	日本	病例对照研究	573	359	PTBD/ERCP	6
Sahora等^[20]	2016	日本	病例对照研究	500	500	ERCP	7
El Nakeeb等^[21]	2016	埃及	病例对照研究	314	274	PTCD/ENBD	7
De Pastena等^[22]	2018	意大利	病例对照研究	714	258	ERCP/PTBD	7
周永平等^[23]	2018	中国	病例对照研究	30	43	ERCP/ENBD	7
许马川等^[24]	2018	中国	病例对照研究	36	42	PTCD/ENBD/ERCP	6
李刚等^[25]	2019	中国	病例对照研究	49	63	ENBD	7
Endo等^[26]	2019	日本	病例对照研究	179	113	ENBD/ERBD	7

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