Scheufele Florian, Schorn Stephan, Demir Ihsan Ekin, Sargut Mine, Tieftrunk Elke, Calavrezos Lenika, Jäger Carsten, Friess Helmut, Ceyhan Güralp Onur
Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
Surgery. 2017 Apr;161(4):939-950. doi: 10.1016/j.surg.2016.11.001. Epub 2016 Dec 30.
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.
梗阻性黄疸是胰腺癌患者常见的临床表现。虽然既往研究提示术前胆道引流有益，但近期证据表明术前胆道引流对术后结局并无显著改善，反而会增加并发症。对于在手术干预前是否采用术前胆道引流治疗恶性梗阻性黄疸，目前尚无明确共识，还是应直接进行切除。因此，我们的目的是阐明术前胆道引流对胰头恶性肿瘤所致梗阻性黄疸患者术后发病率和死亡率的影响。
我们按照PRISMA指南进行了一项荟萃分析，并对医学数据库进行了系统检索。根据预定义标准对结果进行分析。我们汇总了围手术期内总体并发症、伤口感染、胰瘘、腹腔内脓肿及死亡的发生率。
我们最初检索到1816项研究，最终纳入分析的有25项（22项回顾性研究，3项随机对照试验），共6214例患者。分析显示，与先进行手术干预相比，接受术前胆道引流的患者总体并发症（优势比：1.40；95%置信区间：1.14 - 1.72；P = 0.002）及伤口感染（优势比：1.94；95%置信区间：1.48 - 2.53；P < 0.00001）的发生率增加。术前胆道引流对死亡率、胰瘘发生率或腹腔内脓肿形成并无影响。
术前胆道引流对术后结局并无有益影响。术后总体并发症及伤口感染的增加促使我们要明确术前胆道引流的精确指征，反对常规术前胆道减压。
