不同术前胆道引流方式对可切除性恶性梗阻性黄疸种植性转移发生率的影响:Meta分析
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摘要
目的系统评价不同术前胆道引流方式对可切除性恶性梗阻性黄疸(malignant obstructive jaundice,MOJ)种植性转移发生率的影响。方法计算机检索PubMed、EMbase、Web of Science、Cochrane Library、中国生物医学文献数据库、中国知网、万方及维普数据库,纳入比较可切除性MOJ经皮肝胆道引流(percutaneous transhepatic biliary drainage,PTBD)和经内镜胆道引流(endoscopic biliary drainage,EBD)的种植性转移率的临床对照研究。检索时限均从建库至2017年10月。应用比值比(odds,OR)和95%可信区间(confidence,CI)评价结局指标。用Review Manager 5.3软件进行Meta分析。结果共纳入10项研究,其中PTBD组1 085例、EBD组1 379例。分析结果表明,两种术前胆道引流方式的种植性转移率显著不同(OR 4.91,95%CI 0.23～0.53,P<0.00001)。亚组分析发现,在腹膜种植性转移和导管种植性转移上,EBD组均明显少于PTBD组(OR 3.34,95%CI 0.31～0.74,P=0.0008;OR 4.47,95%CI 0.12～0.44,P<0.00001);并且,这一优势在肝门部胆管癌、远端胆管癌和胰腺癌同时得到验证(OR 2.76,95%CI0.17～0.74,P=0.006;OR 3.50,95%CI 0.17～0.60,P=0.0005;OR 6.62,95%CI 0.19～0.40,P<0.00001)。结论本Meta分析显示,在可切除性MOJ的术前胆道引流的选择上,经内镜胆道引流后种植性转移发生率更低,但目前尚缺乏充足的循证医学证据支持。
Objective To compare the effects of percutaneous transhepatic biliary drainage(PTBD) and endoscopic biliary drainage(EBD) on seeding metastasis incidence for resectable malignant obstruction jaundice(MOJ). Methods Databases including PubMed, EMbase, Web of Science, Cochrane Library, sinoMed, CNKI, Wanfang Database and VIP Database. Literature was searched up to Oct. 2017 for controlled clinical trials, which were designed to compare the effects of PTBD and EBD on seeding metastasis incidence between for MOJ. Odds Ratio(OR) with 95% confidence interval(CI) was performed with Review Manager 5.3 software. Results A total of 10 studies were enrolled in this meta-analysis, including 1 085 cases in the PTBD group and 1 379 cases in the EBD group. It was showed that there were significant incidence differences of seeding metastasis between PTBD group and EBD group(OR 4.91, 95%CI 0.23～0.53, P<0.00001). Subgroup analysis showed that both the incidences of peritoneal metastasis and tube-related seeding metastasis were lower in the EBD group(OR 3.34, 95%CI 0.31～0.74, P=0.0008; OR 4.47, 95%CI 0.12～0.44, P<0.00001, respectively), and the advantage of EBD was demonstrated in perihilar cholangiocarcinoma, distal cholangiocarcinoma and pancreatic cancer(OR 2.76, 95%CI 0.17～0.74, P=0.006; OR 3.50, 95%CI 0.17～0.60, P=0.0005; OR 6.62, 95%CI 0.19～0.40, P<0.00001 respectively). Conclusion This Meta analysis shows that the choice of preoperative biliary drainage for resectable malignant obstruction jaundice, endoscopic biliary drainage has lower seeding metastasis incidence, although there is currently not enough evidence.
Objective To compare the effects of percutaneous transhepatic biliary drainage(PTBD) and endoscopic biliary drainage(EBD) on seeding metastasis incidence for resectable malignant obstruction jaundice(MOJ). Methods Databases including PubMed, EMbase, Web of Science, Cochrane Library, sinoMed, CNKI, Wanfang Database and VIP Database. Literature was searched up to Oct. 2017 for controlled clinical trials, which were designed to compare the effects of PTBD and EBD on seeding metastasis incidence between for MOJ. Odds Ratio(OR) with 95% confidence interval(CI) was performed with Review Manager 5.3 software. Results A total of 10 studies were enrolled in this meta-analysis, including 1 085 cases in the PTBD group and 1 379 cases in the EBD group. It was showed that there were significant incidence differences of seeding metastasis between PTBD group and EBD group(OR 4.91, 95%CI 0.23～0.53, P<0.00001). Subgroup analysis showed that both the incidences of peritoneal metastasis and tube-related seeding metastasis were lower in the EBD group(OR 3.34, 95%CI 0.31～0.74, P=0.0008; OR 4.47, 95%CI 0.12～0.44, P<0.00001, respectively), and the advantage of EBD was demonstrated in perihilar cholangiocarcinoma, distal cholangiocarcinoma and pancreatic cancer(OR 2.76, 95%CI 0.17～0.74, P=0.006; OR 3.50, 95%CI 0.17～0.60, P=0.0005; OR 6.62, 95%CI 0.19～0.40, P<0.00001 respectively). Conclusion This Meta analysis shows that the choice of preoperative biliary drainage for resectable malignant obstruction jaundice, endoscopic biliary drainage has lower seeding metastasis incidence, although there is currently not enough evidence.
引文
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[12]Miura F,Sano K,Wada K,et al.Prognostic impact of type of preoperative biliary drainage in patients with distal cholangiocarcinoma[J].Am J Surg,2017,214(2):256-261.
[13]王垒,张勤,彭贵主,等.腹腔镜下胆总管结石胆管探查中C管引流的临床应用价值的Meta分析[J].中华腔镜外科杂志(电子版),2017,10(1):19-24.
[14]Uemura K,Murakami Y,Satoi S,et al.Impact of preoperative biliary drainage on long-term survival in resected pancreatic ductal adenocarcinoma:a multicenter observational study[J].Ann Surg Oncol,2015,22(Suppl 3):S1238-S1246.
[15]Strom TJ,Klapman JB,Springett GM,et al.Comparative long-term outcomes of upfront resected pancreatic cancer after preoperative biliary drainage[J].Surg Endosc,2015,29(11):3273-3281.
[16]Al Mabjoub A,Menahem B,Fohlen A,et al.Preoperative biliary drainage in patients with resectable perihilar cholangiocarcinoma:is percutaneous transhepatic biliary drainage safer and more effective than endoscopic biliary drainage?A Metaanalysis[J].J Vasc Interv Radiol,2017,28(4):576-582.
[17]王垒,彭贵主,叶啟发.经胆囊管胆道引流在肝移植胆道重建中的临床应用价值Meta分析[J].肝胆胰外科杂志,2018(1):31-36,65.
[18]Wang L,Liu Z,Liu X,et al.The hepatectomy efficacy of huge hepatocellular carcinoma and its risk factors:A meta analysis[J].Medicine,2017,96(52):e9226.
[19]Hirano S,Tanaka E,Tsuchikawa T,et al.Oncological benefit of preoperative endoscopic biliary drainage in patients with hilar cholangiocarcinoma[J].J Hepatobiliary Pancreat Sci,2014,21(8):533-540.
[20]Hwang S,Song GW,Ha TY,et al.Reappraisal of percutaneous transhepatic biliary drainage tract recurrence after resection of perihilar bile duct cancer[J].World J Surg,2012,36(2):379-385.
[21]Kawashima H,Itoh A,Ohno E,et al.Preoperative endoscopic nasobiliary drainage in 164 consecutive patients with suspected perihilar cholangiocarcinoma:a retrospective study of efficacy and risk factors related to complications[J].Ann Surg,2013,257(1):121-127.
[22]Komaya K,Ebata T,Fukami Y,et al.Percutaneous biliary drainage is oncologically inferior to endoscopic drainage:a propensity score matching analysis in resectable distal cholangiocarcinoma[J].J Gastroenterol,2016,51(6):608-619.
[23]Komaya K,Ebata T,Yokoyama Y,et al.Verification of the oncologic inferiority of percutaneous biliary drainage to endoscopic drainage:A propensity score matching analysis of resectable perihilar cholangiocarcinoma[J].Surgery,2017,161(2):394-404.
[24]Murakami Y,Uemura K,Hashimoto Y,et al.Does preoperative biliary drainage compromise the long-term survival of patients with pancreatic head carcinoma?[J].J Surg Oncol,2015,111(3):270-276.
[25]Wiggers JK,Groot KB,Coelen RJ,et al.Percutaneous preoperative biliary drainage for resectable perihilar cholangiocarcinoma:no association with survival and no increase in seeding metastases[J].Ann Surg Oncol,2015,22(Suppl 3):S1156-S1163.
[26]Kawakami H,Kuwatani M,Onodera M,et al.Endoscopic nasobiliary drainage is the most suitable preoperative biliary drainage method in the management of patients with hilar cholangiocarcinoma[J].J Gastroenterol,2011,46(2):242-248.
[27]Tempero MA,Malafa MP,Alhawary M,et al.Pancreatic adenocarcinoma,version 2.2017,NCCN clinical practice guidelines in oncology[J].J Natl Compr Canc Netw,2017,15(8):1028-1061.
[2]Mansour JC,Aloia TA,Crane CH,et al.Hilar cholangiocarcinoma:expert consensus statement[J].HPB(Oxford),2015,17(8):691-699.
[3]Banales JM,Cardinale V,Carpino G,et al.Expert consensus document:Cholangiocarcinoma:current knowledge and future perspectives consensus statement from the European Network for the Study of Cholangiocarcinoma(ENS-CCA)[J].Nat Rev Gastroenterol Hepatol,2016,13(5):261-280.
[4]Rerknimitr R,Angsuwatcharakon P,Ratanachu-Ek T,et al.Asia-Pacific consensus recommendations for endoscopic and interventional management of hilar cholangiocarcinoma[J].JGastroenterol Hepatol,2013,28(4):593-607.
[5]Yamaguchi K,Okusaka T,Shimizu K,et al.Clinical practice guidelines for pancreatic cancer 2016 from the Japan Pancreas Society:A synopsis[J].Pancreas,2017,46(5):595-604.
[6]中国抗癌协会.肝门部胆管癌规范化诊治专家共识(2015)[J].中华肝胆外科杂志,2015,21(8):505-511.
[7]顾炯,田开亮,程智礼,等.恶性梗阻性黄疸胰十二指肠切除术前行胆道引流疗效的Meta分析[J].中华消化外科杂志,2015,14(4):298-304.
[8]Celotti A,Solaini L,Montori G,et al.Preoperative biliary drainage in hilar cholangiocarcinoma:Systematic review and meta-analysis[J].Eur J Surg Oncol,2017,43(9):1628-1635.
[9]中国抗癌协会胆道肿瘤专业委员会远端胆管癌与壶腹部癌诊治指南(讨论稿)[C].2011.
[10]Miyazaki M,Yoshitomi H,Miyakawa S,et al.Clinical practice guidelines for the management of biliary tract cancers2015:the 2nd English edition[J].J Hepatobiliary Pancreat Sci,2015,22(4):249-273.
[11]Higuchi R,Yazawa T,Uemura S,et al.ENBD is associated with decreased tumor dissemination compared to PTBD in perihilar cholangiocarcinoma[J].J Gastrointest Surg,2017,21(9):1506-1514.
[12]Miura F,Sano K,Wada K,et al.Prognostic impact of type of preoperative biliary drainage in patients with distal cholangiocarcinoma[J].Am J Surg,2017,214(2):256-261.
[13]王垒,张勤,彭贵主,等.腹腔镜下胆总管结石胆管探查中C管引流的临床应用价值的Meta分析[J].中华腔镜外科杂志(电子版),2017,10(1):19-24.
[14]Uemura K,Murakami Y,Satoi S,et al.Impact of preoperative biliary drainage on long-term survival in resected pancreatic ductal adenocarcinoma:a multicenter observational study[J].Ann Surg Oncol,2015,22(Suppl 3):S1238-S1246.
[15]Strom TJ,Klapman JB,Springett GM,et al.Comparative long-term outcomes of upfront resected pancreatic cancer after preoperative biliary drainage[J].Surg Endosc,2015,29(11):3273-3281.
[16]Al Mabjoub A,Menahem B,Fohlen A,et al.Preoperative biliary drainage in patients with resectable perihilar cholangiocarcinoma:is percutaneous transhepatic biliary drainage safer and more effective than endoscopic biliary drainage?A Metaanalysis[J].J Vasc Interv Radiol,2017,28(4):576-582.
[17]王垒,彭贵主,叶啟发.经胆囊管胆道引流在肝移植胆道重建中的临床应用价值Meta分析[J].肝胆胰外科杂志,2018(1):31-36,65.
[18]Wang L,Liu Z,Liu X,et al.The hepatectomy efficacy of huge hepatocellular carcinoma and its risk factors:A meta analysis[J].Medicine,2017,96(52):e9226.
[19]Hirano S,Tanaka E,Tsuchikawa T,et al.Oncological benefit of preoperative endoscopic biliary drainage in patients with hilar cholangiocarcinoma[J].J Hepatobiliary Pancreat Sci,2014,21(8):533-540.
[20]Hwang S,Song GW,Ha TY,et al.Reappraisal of percutaneous transhepatic biliary drainage tract recurrence after resection of perihilar bile duct cancer[J].World J Surg,2012,36(2):379-385.
[21]Kawashima H,Itoh A,Ohno E,et al.Preoperative endoscopic nasobiliary drainage in 164 consecutive patients with suspected perihilar cholangiocarcinoma:a retrospective study of efficacy and risk factors related to complications[J].Ann Surg,2013,257(1):121-127.
[22]Komaya K,Ebata T,Fukami Y,et al.Percutaneous biliary drainage is oncologically inferior to endoscopic drainage:a propensity score matching analysis in resectable distal cholangiocarcinoma[J].J Gastroenterol,2016,51(6):608-619.
[23]Komaya K,Ebata T,Yokoyama Y,et al.Verification of the oncologic inferiority of percutaneous biliary drainage to endoscopic drainage:A propensity score matching analysis of resectable perihilar cholangiocarcinoma[J].Surgery,2017,161(2):394-404.
[24]Murakami Y,Uemura K,Hashimoto Y,et al.Does preoperative biliary drainage compromise the long-term survival of patients with pancreatic head carcinoma?[J].J Surg Oncol,2015,111(3):270-276.
[25]Wiggers JK,Groot KB,Coelen RJ,et al.Percutaneous preoperative biliary drainage for resectable perihilar cholangiocarcinoma:no association with survival and no increase in seeding metastases[J].Ann Surg Oncol,2015,22(Suppl 3):S1156-S1163.
[26]Kawakami H,Kuwatani M,Onodera M,et al.Endoscopic nasobiliary drainage is the most suitable preoperative biliary drainage method in the management of patients with hilar cholangiocarcinoma[J].J Gastroenterol,2011,46(2):242-248.
[27]Tempero MA,Malafa MP,Alhawary M,et al.Pancreatic adenocarcinoma,version 2.2017,NCCN clinical practice guidelines in oncology[J].J Natl Compr Canc Netw,2017,15(8):1028-1061.