Percutaneous vs. endoscopic pre-operative biliary drainage in hilar cholangiocarcinoma - a systematic review and meta-analysis

Ahmer Hameed; Tony Pang; Judy Chiou; Henry Pleass; Vincent Lam; Michael Hollands; Emma Johnston; Arthur Richardson; Lawrence Yuen

doi:10.1016/j.hpb.2016.03.002

Percutaneous vs. endoscopic pre-operative biliary drainage in hilar cholangiocarcinoma - a systematic review and meta-analysis

HPB (Oxford). 2016 May;18(5):400-10. doi: 10.1016/j.hpb.2016.03.002. Epub 2016 Apr 4.

Authors

Ahmer Hameed¹, Tony Pang¹, Judy Chiou², Henry Pleass¹, Vincent Lam¹, Michael Hollands¹, Emma Johnston³, Arthur Richardson¹, Lawrence Yuen⁴

Affiliations

¹ Department of Surgery, Westmead Hospital, Sydney, Australia; Discipline of Surgery, University of Sydney, Australia.
² Department of Medicine, Westmead Hospital, Sydney, Australia.
³ Department of Surgery, Westmead Hospital, Sydney, Australia.
⁴ Department of Surgery, Westmead Hospital, Sydney, Australia; Discipline of Surgery, University of Sydney, Australia. Electronic address: lawrence.yuen@sydney.edu.au.

Abstract

Background: The strategy for preoperative management of biliary obstruction in hilar cholangiocarcinoma (HCCA) patients with regards to drainage by endoscopic (EBD) or percutaneous (PTBD) methods is not clearly defined. The aim of this study was to investigate the utility, complications and therapeutic efficacy of these methods in HCCA patients, with a secondary aim to assess the use of portal vein embolization (PVE) in patients undergoing drainage.

Methods: Studies incorporating HCCA patients undergoing biliary drainage prior to curative resection were included (EMBASE and Medline databases). Analyses included baseline drainage data, procedure-related complications and efficacy, post-operative parameters, and meta-analyses where applicable.

Results: Fifteen studies were included, with EBD performed in 536 patients (52%). Unilateral drainage of the future liver remnant was undertaken in 94% of patients. There was a trend towards higher procedure conversion (RR 7.36, p = 0.07) and cholangitis (RR 3.36, p = 0.15) rates in the EBD group. Where specified, 134 (30%) drained patients had PVE, in association with a major hepatectomy in 131 patients (98%). Post-operative hepatic failure occurred in 22 (11%) of EBD patients compared to 56 (13%) of PTBD patients, whilst median 1-year survival in these groups was 91% and 73%, respectively.

Discussion: The accepted practice is for most jaundiced HCCA patients to have preoperative drainage of the future liver remnant. EBD may be associated with more immediate procedure-related complications, although it is certainly not inferior compared to PTBD in the long term.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Bile Duct Neoplasms / complications
Bile Duct Neoplasms / diagnosis
Bile Duct Neoplasms / mortality
Bile Duct Neoplasms / therapy*
Cholestasis / diagnosis
Cholestasis / etiology
Cholestasis / mortality
Cholestasis / therapy*
Drainage / adverse effects
Drainage / methods*
Drainage / mortality
Embolization, Therapeutic / methods
Endoscopy* / adverse effects
Endoscopy* / mortality
Hepatectomy
Humans
Jaundice, Obstructive / diagnosis
Jaundice, Obstructive / etiology
Jaundice, Obstructive / mortality
Jaundice, Obstructive / therapy*
Klatskin Tumor / complications
Klatskin Tumor / diagnosis
Klatskin Tumor / mortality
Klatskin Tumor / therapy*
Odds Ratio
Portal Vein
Risk Factors
Survival Analysis
Time Factors
Treatment Outcome