Comparison Between Internal and External Preoperative Biliary Drainage in Periampullary Cancers

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)