Is Percutaneous Transhepatic Biliary Drainage Better than Endoscopic Drainage in the Management of Jaundiced Patients Awaiting Pancreaticoduodenectomy? A Systematic Review and Meta-analysis

被引:47
作者
Dorcaratto, Dimitri [1 ]
Hogan, Niamh M. [2 ]
Munoz, Elena [1 ]
Garces, Marina [1 ]
Limongelli, Paolo [3 ]
Sabater, Luis [1 ]
Ortega, Joaquin [1 ]
机构
[1] Hosp Clon Univ Valencia, Gen & Digest Surg Dept, Hepatobiliary & Pancreat Unit, Valencia, Spain
[2] Royal Coll Surgeons Ireland, Dublin, Ireland
[3] Univ Naples 2, Dept Med Surg Neurol Metab & Aging Sci, Naples, Italy
关键词
POSTOPERATIVE COMPLICATIONS; OBSTRUCTIVE-JAUNDICE; CANCER; OUTCOMES; CONTAMINATION; EXPERIENCE; MORBIDITY; INCREASES; SURVIVAL; EFFICACY;
D O I
10.1016/j.jvir.2017.12.027
中图分类号
R8 [特种医学]; R445 [影像诊断学];
学科分类号
1002 ; 100207 ; 1009 ;
摘要
Purpose: To compare postoperative complications in patients who underwent pancreatoduodenectomy after either endoscopic or percutaneous biliary drain (BD). Material and Methods: Data from studies comparing the rate of postoperative complications in patients who underwent endoscopic BD or percutaneous BD before pancreatoduodenectomy were extracted independently by 2 investigators. The primary outcome compared in the meta-analysis was the risk of postoperative complications. Secondary outcomes were the risks of procedure-related complications, postoperative mortality, postoperative pancreatic fistula, severe complications, and wound infection. For dichotomous variables, the odds ratio (OR) with 95% confidence interval (CI) was calculated. Results: Thirteen studies, including 2334 patients (501 in the percutaneous BD group and 1833 in the endoscopic group), met the inclusion criteria. Postoperative and procedure-related complication rates were significantly lower in the percutaneous BD group (OR = .7, 95% CI = .52.94, P = .02 and OR = .44, 95% CI = .23.84, P = .01, respectively). No significant differences were observed when severe postoperative complications, postoperative mortality, postoperative pancreatic fistula, and wound infection rates were compared. Conclusions: In patients awaiting pancreatoduodenectomy, preoperative percutaneous BD is associated with fewer procedure-related or postoperative complications than endoscopic drain.
引用
收藏
页码:676 / 687
页数:12
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