title: Preoperative biliary stenting versus operation first in jaundiced patients due to malignant lesions in the pancreatic head: A meta-analysis of current literature.
abstract: Obstructive jaundice is a common presenting symptom among patients with pancreatic cancer. While benefits of preoperative biliary drainage have been suggested by previous studies, recent evidence has shown no significant improvements of preoperative biliary drainage on the postoperative outcome but rather an increase of complications. There is no clear consensus on whether to treat malignant obstructive jaundice with preoperative biliary drainage prior to operative intervention or to proceed directly to resection. Thus, our aim was to elucidate the impact of preoperative biliary drainage of obstructive jaundice due to malignant pancreatic head tumors on postoperative morbidity and mortality.
  
  
  
  We conducted a meta-analysis in accordance with the PRISMA guidelines and carried out a systematic search of medical databases. The results were analyzed according to predefined criteria. We pooled the incidence of overall complications, wound infection, pancreatic fistula, intra-abdominal abscess, and death within the perioperative time period.
  
  
  
  We initially identified 1,816 studies, and 25 of these (22 retrospective studies, 3 randomized controlled trials) were finally included in the analysis with a total number of 6,214 patients. Analysis revealed an increased incidence of overall complications (odds ratio: 1.40; 95% confidence interval: 1.14-1.72; P = .002) and wound infections (odds ratio: 1.94; 95% confidence interval: 1.48-2.53; P < .00001) in patients receiving preoperative biliary drainage compared to operative intervention first. Mortality, incidence of pancreatic fistula, or intra-abdominal abscess formation were not affected by preoperative biliary drainage.
  
  
  
  Preoperative biliary drainage does not have a beneficial effect on postoperative outcome. The increase of postoperative overall complications and wound infections urges for precise indications for preoperative biliary drainage and against routine preoperative biliary decompression.
authors.affiliation: Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Scheufele
authors.affiliation: Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Schorn
authors.affiliation: Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
authors.forename: Ihsan Ekin
authors.initials: IE
authors.lastname: Demir
authors.affiliation: Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
authors.forename: Mine
authors.initials: M
authors.lastname: Sargut
authors.affiliation: Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
authors.forename: Elke
authors.initials: E
authors.lastname: Tieftrunk
authors.affiliation: Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
authors.forename: Lenika
authors.initials: L
authors.lastname: Calavrezos
authors.affiliation: Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Jäger
authors.affiliation: Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
authors.forename: Helmut
authors.initials: H
authors.lastname: Friess
authors.affiliation: Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. Electronic address: gueralp.ceyhan@tum.de.
authors.forename: Güralp Onur
authors.initials: GO
authors.lastname: Ceyhan
mesh_terms: D002423:Cause of Death; D018572:Disease-Free Survival; D004322:Drainage / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D008297:Male; D010190:Pancreatic Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D017410:Practice Guidelines as Topic; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D018570:Risk Assessment; D015607:Stents; D013530:Surgical Wound Infection / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D015996:Survival Rate