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Meta-Analysis
. 2013 Feb 28;2013(2):CD008533.
doi: 10.1002/14651858.CD008533.pub3.

Prophylactic gastrojejunostomy for unresectable periampullary carcinoma

Kurinchi Selvan Gurusamy  1 , Senthil Kumar, Brian R Davidson
Affiliations
Meta-Analysis

Prophylactic gastrojejunostomy for unresectable periampullary carcinoma

Kurinchi Selvan Gurusamy et al. Cochrane Database Syst Rev. .

Abstract

Background: The role of prophylactic gastrojejunostomy in patients with unresectable periampullary cancer is controversial.

Objectives: To determine whether prophylactic gastrojejunostomy should be performed routinely in patients with unresectable periampullary cancer.

Search methods: For the initial version of this review, we searched the Cochrane Upper Gastrointestinal and Pancreatic Diseases Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, issue 3), MEDLINE, EMBASE and Science Citation Index Expanded until April 2010. Literature searches were re-run in August 2012.

Selection criteria: We included randomised controlled trials comparing prophylactic gastrojejunostomy versus no gastrojejunostomy in patients with unresectable periampullary cancer (irrespective of language or publication status).

Data collection and analysis: Two review authors independently assessed trials for inclusion and independently extracted data. We analysed data with both the fixed-effect and the random-effects models using Review Manager (RevMan). We calculated the hazard ratio (HR), risk ratio (RR), and mean difference (MD) with 95% confidence intervals (CI) based on an intention-to-treat or available case analysis.

Main results: We identified two trials (of high risk of bias) involving 152 patients randomised to gastrojejunostomy (80 patients) and no gastrojejunostomy (72 patients). In both trials, patients were found to be unresectable during exploratory laparotomy. Most of the patients also underwent biliary-enteric drainage. There was no evidence of difference in the overall survival (HR 1.02; 95% CI 0.84 to 1.25), peri-operative mortality or morbidity, quality of life, or hospital stay (MD 0.97 days; 95%CI -0.18 to 2.12) between the two groups. The proportion of patients who developed long-term gastric outlet obstruction was significantly lower in the prophylactic gastrojejunostomy group (2/80; 2.5%) compared with no gastrojejunostomy group (20/72; 27.8%) (RR 0.10; 95%CI 0.03 to 0.37). The operating time was significantly longer in the gastrojejunostomy group compared with no gastrojejunostomy group (MD 45.00 minutes; 95%CI 21.39 to 68.61).

Authors' conclusions: Routine prophylactic gastrojejunostomy is indicated in patients with unresectable periampullary cancer undergoing exploratory laparotomy (with or without hepaticojejunostomy).

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Conflict of interest statement

None known.

Figures

1
1
Study flow diagram.
2
2
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Prophylactic gastrojejunostomy for unresectable periampullary carcinoma, Outcome 1 Survival.
1.2
1.2. Analysis
Comparison 1 Prophylactic gastrojejunostomy for unresectable periampullary carcinoma, Outcome 2 Peri‐operative morbidity.
1.4
1.4. Analysis
Comparison 1 Prophylactic gastrojejunostomy for unresectable periampullary carcinoma, Outcome 4 Gastric outlet obstruction.
1.5
1.5. Analysis
Comparison 1 Prophylactic gastrojejunostomy for unresectable periampullary carcinoma, Outcome 5 Operating time.
1.6
1.6. Analysis
Comparison 1 Prophylactic gastrojejunostomy for unresectable periampullary carcinoma, Outcome 6 Hospital stay.
See this image and copyright information in PMC

Update of

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