Effect of preoperative biliary drainage in patients with moderately severe obstructive jaundice on the outcomes of pancreatoduodenectomy: A meta-analysis study
Abstract Background The purpose of this meta-analysis was to examine the impact of preoperative biliary drainage (PBD) on the perioperative outcomes of pancreatoduodenectomy (PD) in patients with total bilirubin >100 umol/L.Methods In this meta-analysis, studies that compared the perioperative outcomes of PBD and non-PBD patients with total bilirubin >100 umol/L, and were published in EMBASE, PubMed, the Cochrane library, Web of Science, VIP database, Wanfang data, Chinese biomedical literature and CNKI database from inception up to October 2019 were included. The odds ratios (OR) or mean differences were calculated with 95% confidence intervals (CI).Results Nine trials with 744 patients, which compared PBD (267 patients) with non-PBD (477 patients), were included. There was no significant difference in perioperative mortality between these two groups (OR: 0.51, 95% CI: 0.19 to 1.39; P =0.19). Postoperative hospital stay (mean difference: -2.35, 95% CI: -3.70 to -1.00; P =0.0007), operating time (mean difference: -33.03, 95% CI: -44.14 to 21.93; P <0.00001), estimated blood loss (mean difference: -141.18, 95% CI: -213.25 to -69.11; P =0.0001) and overall morbidity (OR: 0.68, CI: 0.48 to 0.95; P =0.02) were significantly lower in the PBD group than in the non-PBD group.Conclusion Patients who received PBD had similar perioperative mortality, but had decreased postoperative hospital stay, operating time, estimated blood loss and overall morbidity, when compared to patients without PBD. Therefore, PBD should be routinely performed for patients planned for PD with a total bilirubin of >100 umol/L.