The effect of pre-operative biliary drainage in resectable periampullary lesions: a systematic review and meta-analysis.

OBJECTIVE: The effect of a pre-operative biliary stent on complications after pancreaticoduodenectomy (PD) remains controversial. MATERIALS AND METHOD: We conducted a meta-analysis according to the preferred reporting items for systematic reviews and meta-analyses guidelines, and PubMed, Web of Science Knowledge, and Ovid's databases were searched by the end of February 2023. 35 retrospective studies and 2 randomized controlled trials with a total of 12641 patients were included. RESULTS: The overall complication rate of the pre-operative biliary drainage (PBD) group was significantly higher than the no-PBD group (odds ratio [OR] 1.46, 95% confidence interval [CI] 1.22-1.74; p < 0.0001), the incidence of post-operative delayed gastric emptying was increased in patients with PBD compared those with early surgery (OR 1.21, 95% CI: 1.02-1.43; p = 0.03), and there was a significant increase in post-operative wound infections in patients receiving PBD with an OR of 2.2 (95% CI: 1.76-2.76; p < 0.00001). CONCLUSIONS: PBD has no beneficial effect on post-operative outcomes. The increase in post-operative overall complications and wound infections urges the exact indications for PBD and against routine pre-operative biliary decompression, especially for patients with total bilirubin < 250 umol/L waiting for PD.

OBJETIVO: El efecto de una endoprótesis biliar pre-operatoria sobre las complicaciones después de la pancreaticoduodenectomía sigue siendo controvertido. MATERIALES Y MÉTODO: Se llevó a cabo un metaanálisis siguiendo las directrices PRISMA y se realizaron búsquedas en PubMed, Web of Science Knowledge y la base de datos de Ovid hasta finales de febrero de 2023. Se incluyeron 35 estudios retrospectivos y 2 ensayos controlados aleatorizados, con un total de 12,641 pacientes. RESULTADOS: La tasa global de complicaciones del grupo drenaje biliar pre-operatorio (PBD) fue significativamente mayor que la del grupo no-PBD (odds ratio [OR]: 1.46; intervalo de confianza del 95% [IC 95%]: 1.22-1.74; p < 0.0001), la incidencia de vaciado gástrico retardado posoperatorio fue mayor en los pacientes con PBD en comparación con los de cirugía precoz (OR: 1.21; IC95%: 1.02-1.43; p = 0.03), y hubo un aumento significativo de las infecciones posoperatorias de la herida en los pacientes que recibieron PBD (OR: 2.2; IC 95%: 1.76-2.76; p < 0.00001). CONCLUSIONES: El drenaje biliar pre-operatorio no tiene ningún efecto beneficioso sobre el resultado posoperatorio. El aumento de las complicaciones posoperatorias globales y de las infecciones de la herida urge a precisar las indicaciones de PBD y a desaconsejar la descompresión biliar pre-operatoria sistemática, en especial en pacientes con bilirrubina total inferior a 250 µmol/l en espera de pancreaticoduodenectomía.

BURSECTOMY IN GASTRIC CANCER SURGERY: A META-ANALYSIS.

BACKGROUND: Bursectomy consists of surgically removing the peritoneal lining covering the pancreas and the anterior plane of the transverse mesocolon during gastrectomy. However, there are little data to indicate whether bursectomy has a clinical benefit. OBJECTIVE: The objective of this study was to study the effect of bursectomy on complications, recurrence, and overall survival of patients with gastric cancer. METHODS: The publicly available literature published from January 2000 to July 2017 concerning gastrectomy with bursectomy and standard gastrectomy for gastric cancer was retrieved by searching the national and international online databases. Meta-analysis was performed after the data extraction process. RESULTS: Eight studies were finally included for a total of 1644 patients, of whom 644 underwent bursectomy and 1000 received standard gastrectomy without bursectomy. As shown by the meta-analysis results, there were no statistically significant differences in the presence of total post-operative complications (odds ratio [OR] = 1.06, 95% confidence interval [CI] [0.83-1.35], p = 0.63), overall recurrence (OR = 1.07, 95% CI [0.77-1.50], p = 0.68), 3-year overall survival (OR = 1.30, 95% CI [0.82-2.07], p = 0.26), and 5-year overall survival (OR = 0.91, 95% CI [0.66-1.27], p = 0.58). CONCLUSION: Although application of bursectomy in radical gastrectomy did not increase post-operative complications, it offered no benefit to control tumor recurrence or improve overall survival.

Bursectomy in gastric cancer surgery: a meta-analysis

Abstract Background Bursectomy consists of surgically removing the peritoneal lining covering the pancreas and the anterior plane of the transverse mesocolon during gastrectomy. However, there are little data to indicate whether bursectomy has a clinical benefit. Objective The objective of this study was to study the effect of bursectomy on complications, recurrence, and overall survival of patients with gastric cancer. Methods The publicly available literature published from January 2000 to July 2017 concerning gastrectomy with bursectomy and standard gastrectomy for gastric cancer was retrieved by searching the national and international online databases. Meta-analysis was performed after the data extraction process. Results Eight studies were finally included for a total of 1644 patients, of whom 644 underwent bursectomy and 1000 received standard gastrectomy without bursectomy. As shown by the meta-analysis results, there were no statistically significant differences in the presence of total post-operative complications (odds ratio [OR] = 1.06, 95% confidence interval [CI] [0.83-1.35], p = 0.63), overall recurrence (OR = 1.07, 95% CI [0.77-1.50], p = 0.68), 3-year overall survival (OR = 1.30, 95% CI [0.82-2.07], p = 0.26), and 5-year overall survival (OR = 0.91, 95% CI [0.66-1.27], p = 0.58). Conclusion Although application of bursectomy in radical gastrectomy did not increase post-operative complications, it offered no benefit to control tumor recurrence or improve overall survival.