Pancreatectomy with and without preoperative biliary drainage: A systematic review and meta analysis.

Abstract

e16426 Background: Preoperative biliary drainage (PBD) is commonly performed in patients with obstructive jaundice due to pancreatic or biliary tumors prior to pancreatectomy. While intended to reduce perioperative complications, its clinical benefit remains controversial, with concerns regarding increased infection and morbidity. This systematic review and meta-analysis aimed to evaluate the impact of PBD on postoperative outcomes, mortality, and perioperative parameters in patients undergoing pancreatectomy. Methods: We conducted a systematic search of PubMed, Embase, and Cochrane Library for randomized controlled trials, non-randomized trials, and observational studies comparing pancreatectomy with PBD versus pancreatectomy alone. Nine studies encompassing 6,572 patients (4,291 in the PBD group; 2,281 in the control group) met inclusion criteria. Outcomes analyzed included overall and major complications, surgery-related complications (postoperative pancreatic fistula [POPF], biliary leakage, surgical site infection, pneumonia, thromboembolic events), bile culture positivity, reoperation rates, 30-day and in-hospital mortality, operative time, blood loss, transfusion requirements, and total hospital stay. Pooled odds ratios (OR) or mean differences (MD) with 95% confidence intervals (CI) were calculated using random-effects models. Results: PBD was associated with a higher risk of major complications (OR 1.22; 95% CI 1.03–1.44) and significantly increased bile culture positivity (OR 14.02; 95% CI 9.74–20.19). Overall complications (OR 1.10; 95% CI 0.98–1.25), POPF (OR 1.08; 95% CI 0.89–1.31), biliary leakage (OR 0.67; 95% CI 0.47–1.13), surgical site infection (OR 1.08; 95% CI 0.89–1.29), pneumonia (OR 1.11; 95% CI 0.82–1.50), thromboembolic events (OR 0.86; 95% CI 0.60–1.23), and reoperation rates (OR 1.00; 95% CI 0.76–1.31) were not significantly different. In-hospital mortality was higher in the PBD group (OR 3.32; 95% CI 1.28–8.66), whereas 30-day mortality did not differ significantly (OR 1.31; 95% CI 0.82–2.07). PBD increased operative time (MD 12.04 min; 95% CI 9.27–15.54), intraoperative blood loss (MD 78.94 mL; 95% CI 65.67–92.20), and total hospital stay (MD 4.44 days; 95% CI 4.08–4.81), without significantly affecting transfusion requirements (MD –0.35 units; 95% CI –0.81–0.10). Conclusions: Preoperative biliary drainage prior to pancreatectomy is associated with increased major complications, higher bile contamination, longer operative time, and prolonged hospital stay, without significant improvement in 30-day mortality or overall postoperative complications. These findings suggest careful patient selection for PBD, reserving it for cases with severe jaundice or cholangitis.