The Role of the Preoperative Endoscopic Drainage in the Malignant Obstructive Jaundice

Constantinos S. Mammas, MD MSC PhD, Andreas Polydorou, Associate Professor, Nikolaos Arkadopoulos, Assistant Professor, Dimitrios Lappas, Assistant Professor, Vasileios Smyrniotis, Professor. National and Kapodistrian University of Athens, Aretaieion University Hospital, Surgical Experimental Unit ‘K.TOUNTAS’,

Background: Preoperative biliary drainage (PBD) in Malignant Obstructive Jaundice (MOJ) remains controversial.
Aim: This project is a meta-analysis that compares the impact of PBD and Surgery (DS=S: pancreatectomy and/or hepatobiliary resection) in the formation of morbidity and mortality after PBD+S.
Material and Methods: The impact of PBD on morbidity and mortality in MOJ treatment was assessed by: 1. Systematic referencing in the medical databases (HSR/PUBMED) 2. Typing the key words ‘’obstructive jaundice, biliary drainage, liver surgery, complications, morbidity, mortality’’ under selection criteria: a) that articles were published between 2000-10, b) all or the majority of data were collected between 2000-10, c) MOJ patients undertook pancreatic, biliary and/or hepatic therapeutical resection, d) MOJ patients undertook endoscopic PBD preoperatively. Five final articles fulfilled the stated criteria consisting of 386 MOJ patients (114 underwent pancreaticoduodenectomy, 51 hepatobiliary resections, 102 PBD).
Results: 1. There is no significant difference in the mortality rate between DS and PBD+S (OR=0.39, 95% CI: (0.10 – 1.57), 2. Patients treated with PBD+S demonstrated no significant difference in the morbidity rate compared to those treated only with DS (OR=3.75, 95%, CI:(0.76 – 18.51), 3. Comparison of the morbidity rate between PBD and S showed a significant difference favouring the second . (OR=0.04, 95%, Cl: (0.00 – 0.37).
Conclusion: There is no significant difference in the mortality rate between S and PBD+S. The morbidity rate of surgery for MOJ is significantly higher than that of PBD. Concequently, surgery seems to be the decisive factor that finally forms the morbidity rate after PBD+S. Thus, it is documented the need for stratified and prospective research protocols on the role of PBD in MOJ.
 

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