ABSTRACT
ObjectiveTo investigate the clinical effect and safety of endoscopic nasobiliary drainage (ENBD) versus endoscopic biliary stenting (EBS) in preoperative biliary drainage for low-level malignant obstructive jaundice. MethodsChinese and English databases were searched for control studies on the clinical effect of ENBD versus EBS in preoperative biliary drainage for low-level malignant obstructive jaundice published up to August 2020. After quality assessment and data extraction were performed for the studies included, RevMan 53 software was used to perform the meta-analysis. ENBD and EBS were compared in terms of incidence rates of preoperative cholangitis and preoperative pancreatitis, stent dysfunction rate, overall incidence rate of complications before and after surgery, and rate of postoperative pancreatic leakage. ResultsSix studies involving 1182 patients were included. The meta-analysis showed that there were no significant differences between the ENBD group and the EBS group in incidence rate of preoperative pancreatitis (odds ratio ［OR］=0.66, 95% confidence interval ［CI］: 0.44-0.99, P=0.05), stent dysfunction rate (OR=1.14, 95% CI: 0.56-2.31, P=0.72), and overall incidence rate of complications before and after surgery (OR=0.69, 95% CI: 0.41-1.15, P=0.15). Compared with the EBS group, the ENBD group had significant reductions in incidence rate of preoperative cholangitis (OR=0.34, 95% CI: 0.23-0.50, P＜0.000 01) and rate of postoperative pancreatic leakage (OR=0.53, 95% CI: 0.32-0.88, P=0.01). ConclusionPreoperative biliary drainage with ENBD is superior to EBS in patients with well-diagnosed low-level malignant obstructive jaundice. More large multicenter randomized controlled trials are needed in the future to verify this conclusion.
ABSTRACT
ObjectiveTo investigate the safety and clinical effect of pancreaticoduodenectomy with total mesopancreas excision (TMpE) versus traditional pancreaticoduodenectomy (PD) in the treatment of pancreatic head carcinoma and periampullary cancer. MethodsPubMed, Web of Science, Cochrane Library, CBM, CNKI, Wanfang Data, and VIP were searched for the Chinese and English articles on the clinical effect of TMpE and PD in the treatment of pancreatic head carcinoma and periampullary cancer published from January 2007 to February 2020. Quality assessment was performed for the articles included, and Revman 5.3 software was used to perform the Meta-analysis. ResultsFive retrospective cohort studies were included after screening, with a total of 358 patients, among whom 188 underwent TMpE and 170 underwent PD. The results of the meta-analysis showed that compared with the PD group, the TMpE group had a significant increase in the incidence rate of pancreatic fistula (odds ratio ［OR］=1.69, 95% confidence interval ［CI］: 1.03-2.78, P=0.04), while there was no significant difference in the incidence rate of postoperative complications between the two groups (OR=1.51, 95% CI: 0.76-2.98, P=0.24). In addition, TMpE improved R0 resection rate (OR=2.89, 95% CI: 1.30-6.43, P=0.009), number of dissected lymph nodes (mean difference ［MD］=5.14, 95% CI: 4.16-6.13, P＜0.001), and 1-year survival rate after surgery (OR=260, 95% CI: 1.45-4.69, P=0.001), without increasing the time of operation (MD=7.74, 95% CI: -42.84 to 58.33, P=076), intraoperative blood loss (MD = -45.89, 95% CI: -198.19 to 106.41, P=0.55), and the length of postoperative hospital stay (MD=-4.62, 95% CI: -16.60 to 7.36, P=0.45). ConclusionTMpE is safe and feasible in the treatment of pancreatic head carcinoma and periampullary cancer and has the advantages of high R0 resection rate and 1-year survival rate after surgery, and therefore, it may become a preferred treatment method for pancreatic head carcinoma and periampullary cancer.