Should preoperative biliary drainage be routinely performed for obstructive jaundice with resectable tumor?

Abstract

Obstructive jaundice is a common clinical manifestation of malignant lesions adjacent to extrahepatic bile duct, ampulla or pancreatic head. Animal experiments and some clinical observations have demonstrated that preoperative biliary drainage could improve liver function as well as reduce endotoxemia, thereby reducing the incidence of perioperative complications. However, a number of randomized, controlled studies have found that preoperative biliary drainage failed to improve prognosis or reduce the incidence of perioperative complications; in contrast, it might increase the incidence of complications and cause extra financial burden on patients. Thus, whether preoperative biliary drainage should be performed or not is controversial. Since clinical randomized controlled studies are more relevant in clinical setting, we believe that preoperative biliary drainage should not be routinely performed for obstructive jaundice with resectable tumors. More randomized, controlled, prospective studies should be conducted for further exploration.

Keywords: Obstructive jaundice; preoperative biliary drainage.

Figure 1

Schematic illustration of stage I surgery procedure for obstructive jaundice caused by ampullary tumor (2). (A) Ligation of the pancreatic artery and gastroduodenal artery; (B) Gastrointestinal anastomosis and disconnection of the common bile duct; (C) Gallbladder and stomach wall anastomosis.

Figure 2

Surgical site of hilarcholangiocarcinoma: malignant obstructive jaundice does not require routine preoperative biliary drainage.