Meta-analysis of the efficacy of preoperative biliary drainage in patients undergoing liver resection for perihilar cholangiocarcinoma

Abstract

A systematic review was performed to evaluate the effect of preoperative biliary drainage (PBD) on outcomes after liver resection in perihilar cholangiocarcinoma (PHCC) patients. Method: MEDLINE and Web of Science were searched up to March 2019. All studies assessing morbidity, mortality, or recurrence in patients who received PBD and hepatectomy for PHCC were included. Mantel-Haenszel tests with a random-effects model were used for meta-analysis. Results: Sixteen studies involving 2162 patients were included. PBD was associated with higher major morbidity odds ratio [OR] = 1.51; 95 % confidence interval [CI] = 1.14-2.00). Selecting patients for PBD based on simple selection criteria was associated with significantly higher major morbidity (OR = 1.57; 95 % CI = 1.10-2.25). In contrast, selecting patients for PBD according to strict criteria resulted in lower major morbidity compared with patients without PBD (OR = 0.51; 95 % CI = 0.18-1.42). PBD did not influence mortality (OR = 1.06; 95 % CI = 0.70-1.61). Tumor recurrence was significantly higher in the PBD group (OR = 2.07; 95 % CI = 1.38-3.11). To decrease PBD-related complications, the duration between PBD and hepatectomy should be shorter than two weeks. Most reports described PBD on the future liver remnant side. Conclusions: Routine PBD cannot be recommended but it may be useful in highly selected patients suffering from cholangitis, malnutrition, and long lasting jaundice, for whom an extended hepatectomy is planned. However, However, routine PBD cannot be recommended due to higher morbidity rate after hepatectomy clear patient selection criteria can be defined for PBD in future multicenter randomized controlled studies.

Guidelines for Perioperative Care for Liver Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations 2022

“…The results of 2 meta-analyses showed that the mortality rate was similar between patients with or without PBD for perihilar cholangiocarcinoma, but that PBD increased the incidence of complications such as pancreatitis, cholangitis, and surgical site infection (SSI) [ 32 , 33 ]. In the meta-analysis by Moole et al [ 34 ], PBD was associated with fewer overall major adverse events than surgery itself, especially in patients undergoing endoscopic PBD.…”

Relieving the bile ducts prior to pancreatoduodenectomy – A retrospective cohort study

“…This is interestingly also the conclusion of an extensive meta-analysis conducted by Moole et al [ 31 ]. Other systematic reviews and meta-analyses comparing PBD in liver surgery have shown PDB in selected patient groups, including jaundiced patients to reduce morbidity and mortality [ 32 , 33 ]. As mentioned earlier, jaundice has systemic effects, and combined with the systemic effects of malignancies, this could explain why PBD could be beneficial in select patients.…”

Left-Side vs. Right-Side Hepatectomy for Hilar Cholangiocarcinoma: A Meta-Analysis

“…Endoscopic biliary drainage and endoscopic nasobiliary drainage are superior to percutaneous transhepatic biliary drainage because they can reduce the incidence of tumor spread. And given the increase in major morbidity, routine preoperative drainage is not recommended 44 . PVE is believed to increased FLR, but there is no consensus on the indication criteria.…”