PRE-OPERATIVE BILIARY DRAINAGE IN THE PERIAMPULLARY NEOPLASIA - A SYSTEMATIC REVIEW

LUCENA, Gustavo Costa Marques de; BARROS, Rinaldo Antunes

doi:10.1590/0102-672020180001e1372

ABSTRACT

Introduction:

Periampular neoplasms represent 5% of all cancers of the gastrointestinal tract with peak incidence in the 7^th decade of life. The most common clinical picture is jaundice, weight loss and abdominal pain. Considering that cholestasis is related to postoperative complications, preoperative biliary drainage was developed to improve the postoperative morbidity and mortality of icteric patients with periampular neoplasias, whether resectable or not.

Objective:

To describe the outcome of patients with periampullary tumors undergoing preoperative biliary drainage with pancreatoduodenectomy.

Method:

The search was performed in the Medline/PubMed and Virtual Health Library databases by means of the combination of descriptors of the Medical Subject Headings. Inclusion criteria were clinical trials, cohorts, studies that analyze the morbidity and mortality of preoperative biliary drainage in Portuguese, English and Spanish. Exclusion criteria were studies published more than 10 years ago, experimental studies, systematic reviews and articles with WebQualis C or smaller journal in the area of Medicine I or Medicine III. Of the 196 references found, 46 were obtained for reading with quality assessed through the Checklist Strengthening the Reporting of Observational Studies in Epidemiology. Eight studies were selected for review.

Results:

A total of 1116 patients with a sample ranging from 48 to 280 patients and a mean age of 48 to 69 years were obtained. Of the eight studies, four observed a higher rate of bleeding in drained patients; three a higher rate of positive bile culture in the intervention group; site and cavitary infection, and biliopancreatic leaks were more common in the drainage group in two studies each. The death outcome and rate of reoperation were observed in larger numbers in the control group in one study each.

Conclusion:

Preoperative intervention leads to a higher rate of infectious complications and bleeding.

HEADINGS:
Ampulla of Vater; Neoplasms; Drainage; Bile; Obstructive jaundice

[1] Correspondence: Gustavo Costa Marques de Lucena E-mail; gustavocmlucena@gmail.com

Reference	Country, year	n	Mean age	Type of study
Bhati et al.	United Kingdom, 2007	48	48 years¹1 Amico EC, Alves JR, Silveira L, João AS, Guimarães PLFC, Barreto EJSS, et al. Complicações após pancreatectomias: estudo prospectivo após as novas classificações GIEDFP e GIECP. Arq Bras Cir Dig. 2013;26(3):213-8.; 50 years²2 Arkadopoulos N, Kyriazi MA, Papanikolaou IS, Vasiliou P, Theodoraki K, Lappas C, et al. Preoperative Biliary Drainage of Severely Jaundiced Patients Increases Morbidity of Pancreaticoduodenectomy: Results of a Case-Control Study. World J Surg [Internet]. 2014;38(11):2967-72.	Retrospective cohort
Mezhir et al.	USA, 2009	188	69 years ¹; 68 years ²	Prospective cohort
Herzog et al.	Germany, 2009	80	61 years ¹; 66 years	Prospective cohort
Abdullah et al.	Singapore, 2009	82	62 years ¹; 65 years ²	Retrospective cohort
Coates et al.	USA, 2009	90	65 years ¹; 66 years ²	Retrospective cohort
Morris-Stiff et al.	United Kingdom, 2011	280	65,6 years ^1,2	Prospective cohort
van der Gaag et al.	Netherlands, 2010	196	64,7 years ^1,2	Randomized clinical trial
Arkadopoulos et al.	Greece, 2014	152	58 years ¹; 57 years ²	Retrospective cohort

Author, year of publication	Study site	n	Main results	Limitations
Bhati CS et al, 2007	United Kingdom	48	Sepsis (p »0.018). operative wound infection(p = 0.037) and small bile leakage(p = 0.043)were higher in the PBD group than in the control group	Then of the study is small; part of the patients were not drained in the center that carried out the study
Mezhir JJ et al. 2009	USA	188	Surgical wound infection (p = 0.01). infections (p = 0.002), intra-abdominal abscess (p =0.03). mean intraoperative blood loss(p = 0.04), and positive bile culture (p <0.01) were higher in the PBD group. However, the death outcome was more present in the non PBD group.
Herzog T e tal. 2009	Germany	80	The DBPO group presented a higher percentage of positive bile culture intraoperatively (p <0.001).	Then of the study is small
Abdullah SA et al. 2009	Singapore	82	The rate of surgical wound infection of the control group was higher than the intervention group(p = 0.01)	Then of the study is small
Coates JM et al. 2009	USA	90	The PBD group presented greater dissemination to regional lymph nodes (p =0.001) and greater blood loss (p =0.03). The control group had a higher reoperation rate (p = 0.02).	Then of the study is small
Morris-Stiff G et at, 2001	United Kingdom	280	The PBD group had a higher complication rate (p = 0.03), higher number of positive cultures (p = 0.000002), more pancreatic leakage (p =0.013) and gastrointestinal or intraabdominal bleeds (p = 0, 03)
van der Gaag NA et al., 2010	Netherlands	196	The patients in the control group had a lower rate of complications than the intervention group(p <0.001).	The groups were not equivalent, the DBPO group had more men (p = 0.01) and was leaner (p = 0.03) than the control group
Arkadopoulus et al. 2014	Greece	152	The control group had shorter surgical time(p <0.00001), lower intraoperative blood loss (p = 0.0016). and lower number of committed lymph nodes (p = 0.0077). The intervention group had more infected intra-abdominal collections (p = 0.02), chest infection (p =0.03). morbidities percentage (p =0.04) and hospitalization time (p = 0.0001).

Brasil