ArticleInternational journal of surgery (London, England)2026
Impact of preoperative internal versus external biliary drainage on surgical and oncological outcomes after pancreaticoduodenectomy: a systematic review and meta-analysis.
Article in International journal of surgery (London, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Abstract
Background: Preoperative biliary drainage is required for complicated malignant obstructive jaundice before pancreaticoduodenectomy (PD). However, the impact of internal (IntBD) versus external biliary drainage (ExtBD) on post-pancreatectomy clinical and oncological outcomes remains controversial. Methods: Systematic search of MEDLINE, EMBASE, CENTRAL, Web of Science, and ClinicalTrials.gov (through January 2025) identified studies comparing IntBD and ExtBD before PD. Meta-analyses were performed using random-effects modeling to calculate risk ratios (RRs), mean differences (MDs), and respective 95% confidence intervals. The primary outcome was overall postoperative morbidity; secondary outcomes included specific surgical complications and oncological endpoints. Results: 6832 patients from 31 retrospective cohort studies and 1 randomized trial were analyzed. ExtBD was associated with a lower overall complication rate after PD (RR: 1.31 [1.08-1.59]; Conclusions: ExtBD was associated with lower postoperative morbidity after PD, whereas oncological outcomes remain uncertain. Given the low methodological quality and predominantly retrospective design of the included studies, these findings should be considered hypothesis-generating. Prospective trials are needed to clarify the optimal preoperative drainage strategy.
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