Selection of the best preoperative biliary drainage method for patients with hilar cholangiocarcinoma: a Meta-analysis

Abstract

Objective To select the best preoperative biliary drainage (PBD) method for patients with hilar cholangiocarcinoma. Methods The PubMed, EMBASE, Web of Science, CNKI, and Wanfang Database were systematically searched for prospective or retrospective studies on biliary drainage for patients with hilar cholangiocarcinoma with obstructive jaundice. The drainage-related cholangitis, pancreatitis, hemorrhage, and the success rate in relieving jaundice were analyzed. The meta-analysis was performed using the Review Manager 5.3 and the stata 12.0 using a fixed or random effects model. Results This meta-analysis included 12 studies with 1567 patients. The results showed a lower risk of cholangitis with PTBD than EBD (RR=0.60, 95%CI: 0.39~0.95, P<0.05). PTBD also resulted in a lower risk of pancreatitis than EBD (RR=0.30, 95%CI: 0.15~0.59, P<0.05), and a higher rate of successful relief of cholestatic jaundice (RR=2.77, 95%CI: 1.79~4.28, P<0.05). However, the risk of bleeding for PTBD was higher (RR=2.38, 95% CI: 1.12~5.05, P<0.05), the risk of intraoperative blood transfusion increased (RR=1.59, 95% CI: 1.05-2.42, P<0.05), and the risk of celiac metastasis was also increased (RR=3.24, 95%CI: 1.15~9.12, P<0.05) when compared with EBD. The incidence of celiac metastasis was as high as 4.2%. There were no significant differences between PTBD and EBD in the rates of bile leakage, intra-abdominal abscesses, hemorrhage, R0 resection, postoperative hospital stay postoperative complications and in-hospital mortality, what's more, there were no significant differences in the incidence of cholangitis, pancreatitis, and liver abscess between ENBD and EBS. Conclusions The postoperative hospital stay was similar between the two groups. ENBD was a better choice than PTBD for patients who required PBD. PTBD could be used after the failure of ENBD. Key words: Endoscopic biliary drainage; Percutaneous transhepatic biliary drainage; Hilar cholangiocarcinoma; Klatskin tumor; Meta-analysis