Effect of preoperative biliary drainage on malignant obstructive jaundice: a meta-analysis.
OBJECTIVE
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).


CONCLUSIONS
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.
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.
Yu-Dong
YD
Qiu
Jian-Ling
JL
Bai
Fang-Gui
FG
Xu
Yi-Tao
YT
Ding
D015331:Cohort Studies; D004322:Drainage / Q000379:methods*; D005746:Gastric Emptying; D006801:Humans; D041781:Jaundice, Obstructive / Q000601:surgery*; D016239:MEDLINE; D011183:Postoperative Complications / Q000401:mortality*; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome
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