Objective  To systematically evaluate the impact of preoperative biliary drainage (PBD) on postoperative complications in patients with malignant obstructive jaundice undergoing pancreaticoduodenectomy (PD), thereby providing evidence for clinical deci-sion-making.

Methods  A comprehensive search of PubMed, Embase, Web of Science, The Cochrane Library, CNKI, VIP, Wanfang, and CBM databases was conducted for studies published between January 1, 2014 and February 10, 2026. Literature screening, quality assessment, and data extraction were performed according to predefined inclusion/exclusion criteria. Statistical analyses of postoperative complications were conducted using RevMan 5.4 and Stata 17.0.

Results  A total of 42 studies were included, involving 19,036 patients, with 12,156 patients in the PBD group and 6,880 in the non-PBD (NPBD) group. Meta-analysis revealed that the incidence of postoperative hemorrhage was lower in the PBD group than in the NPBD group [OR=0.80, 95% CI (0.66, 0.96), P=0.02]; the incidence of wound infection was higher in the PBD group than in the NPBD group [OR=1.92, 95% CI (1.54, 2.39), P<0.001]. No statistically significant differences were observed between the two groups in the incidence of overall complications, pancreatic fistula, bile leakage, intra-abdominal infection, delayed gastric emptying, or perioperative mortality (P> 0.05).

Conclusion  Preoperative biliary drainage significantly reduces the risk of postoperative bleeding but may increase the incidence of wound infection. Current evidence is insufficient to support that PBD can comprehensively improve prognosis. Future multicenter randomized controlled trials are warranted to identify optimal candidates and standardize procedural protocols for PBD.

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