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

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.

Biliary stenting for hilar malignant biliary obstruction

“…In addition, as a preoperative drainage, especially in the case of resectable HCCA, seeding metastasis by PTBD is a serious problem. A systematic review showed that the incidence of seeding metastasis was significantly higher in the PTBD group (10.5% in ERBD group vs 22.0% in PTBD group, OR = 0.35, 95% CI: 0.23–0.53) …”

“…A systematic review showed that the incidence of seeding metastasis was significantly higher in the PTBD group (10.5% in ERBD group vs 22.0% in PTBD group, OR = 0.35, 95% CI: 0.23-0.53). 19 From a technical point of view, PTBD is difficult if the intrahepatic bile duct (IHD) is not fully dilated, or if there are multiple liver metastases, ascites, or blood clots. Multiple percutaneous punctures are also needed for multiple stents, and the placement of metal stents usually requires two intervening steps.…”

Comparison of effect between nasobiliary drainage and biliary stenting in malignant biliary obstruction: a systematic review and updated meta-analysis

“…It has been reported that PBD can cause complications such as biliary hemorrhage, acute cholangitis, and acute pancreatitis, with an incidence of 8%. In addition, PBD can also cause bacterial contamination of bile, and therefore increases the probability of infection after an operation, and even metastasis of tumors [5][6][7]. PTBD belongs to invasive drainage, which can be placed with multiple drainage tubes to relieve jaundice.…”

Rare Abdominal Wall Metastasis following Curative Resection of Gastric Cancer: What Can Be Learned from the Use of Percutaneous Catheters?

“…The most corroborated risk is transhepatic drainage for malignant biliary obstructions [14][15][16]. The prevalence of catheter tract seeding is somewhat disputed, with two reviews displaying rates ranging from as low as 6% to as high as 22% [17,18]. In addition, soft tissue spread is not unique to GI malignancies; for example, an intracranial glioma has been reported to disperse into the peritoneum via a ventricular shunt [19].…”