Preoperative biliary drainage for perihilar cholangiocarcinoma: A Meta-analysis

Abstract

Objective To systematically review the effectiveness and safety of percutaneous transhepatic biliary drainage (PTBD) versus endoscopic biliary drainage (EBD) for preoperative biliary drainage in patients with Klatskin Tumors. Methods The Pubmed, Embase, Web of Science, CNKI, VIP and WanFang Data from January 1998 to December 2017 were searched for published studies which compared endoscopic biliary drainage (EBD) with percutaneous transhepatic biliary drainage (PTBD) for preoperative biliary drainage. A Meta-analysis was then performed using the Revman 5.3 software. Results Seven cohort studies were included. There were 366 patients in the PTBD group, and 400 patients in the EBD groups. When compared with EBD, PTBD was associated with a lower risk of cholangitis (OR=0.31, 95% CI 0.20~0.48, P<0.05), a lower risk of pancreatitis (OR=0.11, 95% CI 0.04~0.34, P<0.05), and a lower risk of overall complications (OR=0.48, 95% CI 0.30~0.77, P=0.002). The rate of conversion from one procedure to the other was significantly lower in the PTBD group than the EBD group. The initial technical success rate and postoperative morbidity and mortality rates were similar in the 2 groups. Conclusion In patients with Klatskin tumors who require PBD, PTBD is a better initial biliary drainage method with lower incidences of procedure-related cholangitis, pancreatitis overall complications and conversion to other drainage procedures. Key words: Percutaneous transhepatic biliary drainage (PTBD); Endoscopic biliary drainage (EBD); Preoperative biliary drainage (PBD); Perihilar cholangiocarcinoma; Meta-analysis