Preoperative Biliary Drainage in Patients with Resectable Perihilar Cholangiocarcinoma: Is Percutaneous Transhepatic Biliary Drainage Safer and More Effective than Endoscopic Biliary Drainage? A Meta-Analysis.
OBJECTIVE
To determine the best initial procedure for performing preoperative biliary drainage in patients with resectable perihilar cholangiocarcinoma (PHCC).


METHODS
MEDLINE/PubMed and the Cochrane database were searched for all studies published until June 2016 comparing endoscopic biliary drainage (EBD) and percutaneous transhepatic biliary drainage (PTBD) for preoperative biliary drainage. Meta-analysis was performed by using Review Manager 5.3 software.


RESULTS
Four retrospective studies were identified that met the criteria. The analysis was performed on 433 patients who underwent preoperative biliary drainage for resectable PHCC. Of those, 275 (63.5%) had EBD and 158 (36.5%) had PTBD as the initial procedure. The overall procedure-related morbidity rate was significantly lower in the PTBD group than in the EBD group (39 of 147 [26.5%] vs 82 of 185 [44.3%]; odds ratio [OR], 2.23; 95% confidence interval [CI], 1.39-3.57; P = .0009). The rate of conversion from one procedure to the other was significantly lower in the PTBD group than in the EBD group (8 of 158 [5.0%] vs 73 of 275 [26.5%]; odds ratio, 4.76; 95% CI, 2.71-8.36; P < .00001). Pancreatitis occurred only in the EBD group (25 of 275 [9.0%] vs 0 of 158; OR, 7.46; 95% CI, 3.02-18.44; P < .0001). The cholangitis rate was significantly lower in the PTBD group than in the EBD group (12 of 158 [7.6%] vs 93 of 275 [33.8%]; OR, 5.41; 95% CI, 2.75-10.63; P < .00001).


CONCLUSIONS
This meta-analysis shows that PTBD has a lower rate of complications than EBD as the initial procedure to perform preoperative biliary drainage in resectable PHCC. PTBD is associated with less conversion and lower rates of pancreatitis and cholangitis.
Unité Mixte de Recherche 1086, Institut National Scientifique et Recherche Médicale "Cancers et prevention", Centre François Baclesse Caen, France.
Aimen
A
Al Mahjoub
Unité Mixte de Recherche 1086, Institut National Scientifique et Recherche Médicale "Cancers et prevention", Centre François Baclesse Caen, France; Department of Digestive Surgery, University Hospital of Caen Caen, France; Medical University of Caen, Caen, France.
Benjamin
B
Menahem
Department of Radiology, University Hospital of Caen Caen, France.
Audrey
A
Fohlen
Department of Hepatogastroenterology, University Hospital of Caen Caen, France.
Benoit
B
Dupont
Unité Mixte de Recherche 1086, Institut National Scientifique et Recherche Médicale "Cancers et prevention", Centre François Baclesse Caen, France; Department of Digestive Surgery, University Hospital of Caen Caen, France; Medical University of Caen, Caen, France.
Arnaud
A
Alves
Unité Mixte de Recherche 1086, Institut National Scientifique et Recherche Médicale "Cancers et prevention", Centre François Baclesse Caen, France.
Guy
G
Launoy
Unité Mixte de Recherche 1086, Institut National Scientifique et Recherche Médicale "Cancers et prevention", Centre François Baclesse Caen, France; Department of Digestive Surgery, University Hospital of Caen Caen, France; Medical University of Caen, Caen, France. Electronic address: lubrano-j@chu-caen.fr.
Jean
J
Lubrano
D001650:Bile Duct Neoplasms / Q000601:surgery*; D016009:Chi-Square Distribution; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects; D002761:Cholangitis / Q000209:etiology; D004322:Drainage / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D018285:Klatskin Tumor / Q000601:surgery*; D016017:Odds Ratio; D010195:Pancreatitis / Q000209:etiology; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome