Z Gastroenterol 2019; 57(01): e33-e34
DOI: 10.1055/s-0038-1677130
2. Clinical Hepatology, Surgery, LTX
Georg Thieme Verlag KG Stuttgart · New York

Meta-analysis of the efficacy of preoperative biliary drainage in hilar cholangiocarcinoma

K Hoffmann
1   Department of General, Visceral, and Transplantation Surgery, University of Heidelberg
,
E Khajeh
1   Department of General, Visceral, and Transplantation Surgery, University of Heidelberg
,
O Ghamarnejad
1   Department of General, Visceral, and Transplantation Surgery, University of Heidelberg
,
M Nikdad
1   Department of General, Visceral, and Transplantation Surgery, University of Heidelberg
,
S Mohammadikhajehdehi
1   Department of General, Visceral, and Transplantation Surgery, University of Heidelberg
,
M Golriz
1   Department of General, Visceral, and Transplantation Surgery, University of Heidelberg
,
A Mehrabi
1   Department of General, Visceral, and Transplantation Surgery, University of Heidelberg
› Author Affiliations
Further Information

Publication History

Publication Date:
04 January 2019 (online)

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Background:

Preoperative biliary drainage (PBD) is one of the most challenging options in perioperative management of patients with perihilar cholangiocarcinoma (PHCC). However, there is not adequate evidence regarding selection of PHCC patients who can benefit from PBD. We aimed to evaluate the outcome of PBD before liver resection for PHCC according to the patients' selection criteria.

Methods:

MEDLINE and Web of Science databases were searched systematically for relevant literature up to May 2018. All studies assessing morbidity or mortality in patients with PHCC where PBD was used were included. Study quality was assessed using MINORS criteria.

Results:

There was no significant difference regarding overall morbidity and mortality between PBD and no-PBD groups. Patients in PBD group had significantly higher major morbidity rate compared to no-PBD group (OR = 1.52; 95%CI = 1.12 to 2.06). Subgroup analyses revealed that performing PBD as routine in all patients significantly increased major morbidity rate after liver resection (OR = 1.65; 95%CI = 1.12 to 2.42). Similarly, application of PBD using a simple patient selection criteria (i.e. combination of routine use of PBD with application of PBD for patients with jaundice or bilirubin > 3) significantly increased the major morbidity rate (OR = 1.58; 95%CI = 1.11 to 2.26). Surprisingly, the results revealed that PBD did not increase postoperative major morbidity after liver resection in highly selected patients and showed even a nonsignificant tend to decrease major morbidity rate (OR = 0.51; 95%CI = 0.18 to 1.42). Patients in PBD group had significantly higher recurrence rate compared with no-PBD group (OR = 1.78; 95% CI = 1.14 to 2.80).

Conclusions:

We suggest that PBD should not be used routinely in all PHCC patients before liver resection. However, benefits of performing PBD in some selected patients needs further assessing by large sample randomized controlled trials.