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Efficacy of preoperative biliary drainage in malignant obstructive jaundice: a meta-analysis and systematic review

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Title: Efficacy of preoperative biliary drainage in malignant obstructive jaundice: a meta-analysis and systematic review
Author(s): Moole, Harsha; Bechtold, Matthew; Puli, Srinivas R.
Subject(s): Preoperative biliary drainage Malignant obstructive jaundice Pancreatic head cancer Peri-ampullary malignancy Cholangiocarcinoma Pancreaticoduodenectomy
Abstract: Background: In patients requiring surgical resection for malignant biliary jaundice, it is unclear if preoperative biliary drainage (PBD) would improve mortality and morbidity by restoration of biliary flow prior to operation. This is a meta-analysis to pool the evidence and assess the utility of PBD in patients with malignant obstructive jaundice. The primary outcome is comparing mortality outcomes in patients with malignant obstructive jaundice undergoing direct surgery (DS) versus PBD. The secondary outcomes include major adverse events and length of hospital stay in both the groups. Methods: Studies using PBD in patients with malignant obstructive jaundice were included in this study. For the data collection and extraction, articles were searched in MEDLINE, PubMed, Embase, Cochrane Central Register of Controlled Trials & Database of Systematic Reviews, etc. Pooled proportions were calculated using both Mantel-Haenszel method (fixed effects model) and DerSimonian-Laird method (random effects model). Results: Initial search identified 2230 reference articles, of which 204 were selected and reviewed. Twenty-six studies (N = 3532) for PBD in malignant obstructive jaundice which met the inclusion criteria were included in this analysis. The odds ratio for mortality in PBD group versus DS group was 0.96 (95 % CI = 0.71 to 1.29). Pooled number of major adverse effects was lower in the PBD group at 10.40 (95 % CI = 9.96 to 10.83) compared to 15.56 (95 % CI = 15.06 to 16.05) in the DS group. Subgroup analysis comparing internal PBD to DS group showed lower odds for major adverse events (odds ratio, 0.48 with 95 % CI = 0.32 to 0.74). Conclusions: In patients with malignant biliary jaundice requiring surgery, PBD group had significantly less major adverse effects than DS group. Length of hospital stay and mortality rate were comparable in both the groups.
Issue Date: 2016-07-11
Publisher: BioMed Central
Citation Info: Moole, Harsha, Matthew Bechtold, and Srinivas R. Puli. "Efficacy of preoperative biliary drainage in malignant obstructive jaundice: a meta-analysis and systematic review." World Journal of Surgical Oncology 14, no. 1 (2016): 1. DOI: 10.1186/s12957-016-0933-2
Type: Article
Description: This is a copy of an article published in the World Journal of Surgical Oncology. © 2016 The Author(s).
ISSN: 1477-7819
Sponsor: The Research Open Access Article Publishing (ROAAP) Fund of the University of Illinois at Chicago for financial support towards the open access publishing fee for this article.
Date Available in INDIGO: 2016-09-14

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