Brief Article
Copyright ©2011 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Jan 21, 2011; 17(3): 391-396
Published online Jan 21, 2011. doi: 10.3748/wjg.v17.i3.391
Effect of preoperative biliary drainage on malignant obstructive jaundice: A meta-analysis
Yu-Dong Qiu, Jian-Ling Bai, Fang-Gui Xu, Yi-Tao Ding
Yu-Dong Qiu, Fang-Gui Xu, Yi-Tao Ding, Department of Hepatobiliary Surgery, Affiliated Drum Tower Hospital, Medical School, Nanjing University, Nanjing 210008, Jiangsu Province, China
Jian-Ling Bai, Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
Author contributions: Qiu YD and Xu FG reviewed the articles and extracted data for further analysis; Bai JL performed the meta-analysis in accordance with the Cochrane Handbook for Systematic Reviews of Interventions; Qiu YD and Ding YT designed the study and wrote the manuscript.
Supported by Key Medical Center for Hepatobiliary Disease of Jiangsu Province, No. ZX200605
Correspondence to: Yi-Tao Ding, MD, Department of Hepatobiliary Surgery, Affiliated Drum Tower Hospital, Medical School, Nanjing University, No. 321 Zhongshan Road, Nanjing 210008, Jiangsu Province, China. yitaoding@hotmail.com
Telephone: +86-25-83304616 Fax: +86-25-83317016
Received: July 13, 2010
Revised: September 27, 2010
Accepted: October 4, 2010
Published online: January 21, 2011
Abstract

AIM: To evaluate the effect of preoperative biliary drainage (PBD) on obstructive jaundice resulting from malignant tumors.

METHODS: According to the requirements of Cochrane systematic review, studies in the English language were retrieved from MEDLINE and Embase databases from 1995 to 2009 with the key word “preoperative biliary drainage”. Two reviewers independently screened the eligible studies, evaluated their academic level and extracted the data from the eligible studies confirmed by cross-checking. Data about patients with and without PBD after resection of malignant tumors were processed for meta-analysis using the Stata 9.2 software, including postoperative mortality, incidence of postoperative pancreatic and bile leakage, abdominal abscess, delayed gastric emptying and incision infection.

RESULTS: Fourteen retrospective cohort studies involving 1826 patients with malignant obstructive jaundice accorded with our inclusion criteria, and were included in meta-analysis. Their baseline characteristics were comparable in all the studies. No significant difference was found in combined risk ratio (RR) of postoperative mortality and incidence of pancreatic and bile leakage, abdominal abscess, delayed gastric emptying between patients with and without PBD. However, the combined RR for the incidence of postoperative incision infection was improved better in patients with PBD than in those without PBD (P < 0.05).

CONCLUSION: PBD cannot significantly reduce the postoperative mortality and complications of malignant obstructive jaundice, and therefore should not be used as a preoperative routine procedure for malignant obstructive jaundice.

Keywords: Malignant obstructive jaundice; Preoperative biliary drainage; Meta-analysis; Mortality; Incidence of complications