Comparison Between Internal and External Preoperative Biliary Drainage in Periampullary Cancers

Prospective Study on the Comparison Between the Clinicopathological Outcomes According to the Methods of Preoperative Biliary Drainage in Periampullary Cancers Causing Obstructive Jaundice

Preoperative biliary drainage methods include percutaneous transhepatic biliary drainage (PTBD), endoscopic nasobiliary drainage (ENBD), and endoscopic retrograde biliary drainage (ERBD). Endoscopic biliary drainages often induce peritumoral inflammation and it increase difficulties in determining a proper resection margin. The purpose of this study is to compare the clinicopathological outcomes according to the methods of preoperative biliary drainage in periampullary cancers causing obstructive jaundice, and to find out a proper biliary drainage method.

Inclusion Criteria:

• patient who have periampullary tumors causing obstructive jaundice
• patient age: ≥20 and ≤85
• resectable state of disease
• no history of previous chemotherapy or radiotherapy
• patients without uncontrollable severe cardiovascular, respiratory disease
• Karnofsky performance scale ≥70
• informed consent

Exclusion Criteria:

• patients with distant metastasis or locally advanced disease with major vascular invasion
• duodenal cancer
• biliary drainage before randomization
• previous chemotherapy or radiotherapy
• uncontrollable active infection except cholangitis
• severe comorbid disease (cardiac, pulmonary, cerebrovascular)