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Comparative Study
. 2019 Jul 5;17(1):116.
doi: 10.1186/s12957-019-1656-y.

A systematic review of the comparison of the incidence of seeding metastasis between endoscopic biliary drainage and percutaneous transhepatic biliary drainage for resectable malignant biliary obstruction

Lei Wang  1   2 , Nanping Lin  1   2 , Fuli Xin  1   2 , Qiao Ke  1   2 , Yongyi Zeng  3   4   5   6 , Jingfeng Liu  1   2   7   8
Affiliations
Comparative Study

A systematic review of the comparison of the incidence of seeding metastasis between endoscopic biliary drainage and percutaneous transhepatic biliary drainage for resectable malignant biliary obstruction

Lei Wang et al. World J Surg Oncol. .

Abstract

Background and aim: Endoscopic biliary drainage (EBD) and percutaneous biliary drainage (PTBD) are the two main strategies of preoperative biliary drainage (PBD) for resectable malignant biliary obstruction (MBO) worldwide, but which is better remains unclear. Seeding metastasis (SM) has been reported repeatedly in the recent decade, although it is rarely taken into consideration in the choice of PBD. Hence, a systematic review was badly warranted to evaluate the incidence of SM between PTBD and EBD in the preoperative treatment of MBO.

Methods: PubMed, MEDLINE, the Cochrane Library, and Web of Science were used to identify any potentially eligible studies comparing the incidence of SM between EBD and PTBD from Nov 1990 to Mar 2018. The effect size was determined by odds ratio (OR) with 95% confidence interval (CI).

Results: Ten studies were enrolled in this study, including 1379 cases in the EBD group and 1085 cases in the PTBD group. Results showed that the incidence of SM in the EBD group was significantly lower than that in the PTBD group (10.5% vs. 22.0%, OR = 0.35, 95% CI 0.23~0.53). Subgroup analysis stratified by the definition of SM showed that the pooled ORs for peritoneal metastasis and tube-related SM between EBD and PTBD were 0.42 (95% CI 0.31~0.57) and 0.17 (95% CI 0.10~0.29), respectively. Subgroup analysis stratified by the location of MBO showed that the pooled ORs for the incidence of SM between EBD and PTBD for perihilar cholangiocarcinoma, distal cholangiocarcinoma, and pancreatic cancer were 0.27 (95% CI 0.13~0.56), 0.32 (95% CI 0.17~0.60), and 0.27 (95% CI 0.19~0.40), respectively.

Conclusion: EBD should be the optimal PBD for MBO considering the SM, but it deserved further validation.

Keywords: Endoscope biliary drainage; Malignant biliary obstruction; Meta-analysis; Percutaneous biliary drainage; Preoperative biliary drainage; Seeding metastasis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of the study selection process for meta-analysis
Fig. 2
Fig. 2
Forest plots of the seeding metastasis rates
Fig. 3
Fig. 3
Subgroup analysis of (a) peritoneal metastasis and (b) tube-related seeding metastasis
Fig. 4
Fig. 4
Subgroup analysis of seeding metastasis rates derived from (a) PHC, (b) DCC, and (c) PC
Fig. 5
Fig. 5
a, b Publication bias and sensitivity analysis
See this image and copyright information in PMC

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