Should preoperative biliary drainage be routinely performed for obstructive jaundice with resectable tumor?

Obstructive jaundice is a common clinical manifestation of malignant lesions adjacent toextrahepatic bile duct, ampulla or pancreatic head. Animal experiments and some clinical observations havedemonstrated that preoperative biliary drainage could improve liver function as well as reduce endotoxemia,thereby reducing the incidence of perioperative complications. However, a number of randomized,controlled studies have found that preoperative biliary drainage failed to improve prognosis or reduce theincidence of perioperative complications; in contrast, it might increase the incidence of complications andcause extra financial burden on patients. Thus, whether preoperative biliary drainage should be performedor not is controversial. Since clinical randomized controlled studies are more relevant in clinical setting,we believe that preoperative biliary drainage should not be routinely performed for obstructive jaundicewith resectable tumors. More randomized, controlled, prospective studies should be conducted for furtherexploration.