Evaluation of prophylactic gastroenterostomy in late periampullary carcinoma

doi:10.3877/cma.j.issn.1674-0793.2007.02.002

Abstract

Abstract:

Objective

To evalute prophylactic gastroenterostomy in patients with late periampullary carcinoma(PAC)using a meta-analysis.

Methods

MEDLINE,EMBASE and PUBMED searchs were supplemented by information from trial registers.Controlled trials for prophylactic gastroenterostomy concomitant with bilio-enteric bypass and bilio-enteric by-pass alone in inoperable periampullary carcinoma.A quantitative meta-analysis using updated information based on inclusion criterion from all available randomized controlled trials and non-randomized controlled trials were carried out by two reviewers.The pirmany meta-analysis was based on gastric outlet obstruction rate.The second was postoperative complications,operative death rate and survival time.

Result

The meta-analysis included 3 randomized controlled trials and 15non-randomized controlled trials.In late periampullary carcinoma,there was a significant decrement for two by-pass procedures in gastric outlet obstruction rate(RR=0.18,P<0.01,RR,relative risk meanes risk in the prophylactic gastroenterostomy concomitant with bilio-enteric bypass group risk in the bilio-enteric bypass alone group;RD=-0.20,P<0.01,RD,rate difference meanes risk in the two by-pass procedures drecreases risk in the bilio-enteric bypass alone procedures,Post-operation complications rate(RR=1.09,P=0.45;RD=0.03,P=0.43);Operative death rate(RR=1.01,P=0.96;RD=0.00,P=0.95).Two research items of three research items show the postoperative survival time two by-pass procedures were longer than bile by-pass only.

Conclusion

Comparing with bilioenteric by-pass only in inoperable periampullary carcinoma.The prophylactic gastroenterostomy concomitant with bilioenteric by-pass decrease significantly occurring rate of gastric outlet obstruction,prolong postoperative survival time,but did not increase postoperative complications,operative death rate.It can increase chance for other treatment and nutrition.

Key words: late pancreatic head carcinoma, advanced pancreatic head carcinoma, unresectable periampullary carcinoma, cholecystoenterostomy, hepaticojunostomy, choledochojejunostomy, prophylactic gastroenterostomy, meta-analysis, RCT

Jin-qiang FU, Zheng-ming LEI. Evaluation of prophylactic gastroenterostomy in late periampullary carcinoma[J]. Chinese Archives of General Surgery(Electronic Edition), 2007, 01(02): 67-73.

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References 22

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作者	手术方式	病例数	样本设计	并发症发生率(%)	手术死亡率(%)	术后平均生存期(月)	术后十二指肠梗阻发生率(%)
Van Heek,	1.Hepaticojejunosto-my and retrocolic gastrojejunostomy	36	RCT	31	30	7.2	5.5
N Tjarda MD eta	2.Hepaticojejunosto-my	29	RCT	28	30	8.4	41.4
Lillemoe,Keith.	1.Hepaticojejunosto-my and retrocolic gastrojejunostomy	44	RCT	32	Nd	8.3	0
MD etal	2.Hepaticojejunostomy	43	RCT	33	Nd	8.3	19
张建军杨信太等	1.胆肠,预防性胃肠“h”型双吻合	18	RCT	Nd	Nd	11.68±1.02	0
张建军杨信太等	2.胆肠吻合	16	RCT	Nd	Nd	9.47±1.33	36.6
李海民窦科峰等	1.胆肠,预防性胃肠双吻合	41	NRCT	Nd	9.8	9.78±1.26	Nd
李海民窦科峰等	2.单纯胆肠内引流	67	NRCT	Nd	9.0	9.08±1.21	32.7
刘玉斌区金锐等	1.胆肠吻合加胃空肠吻合	61	NRCT	Nd	4.9	13.9	0
刘玉斌区金锐等	2.单纯肝(胆)总管空肠吻合术	53	NRCT	Nd	5.7	10.3	31.8
张彦林李国胜等	1.肝(胆)总管空肠Roux-y吻合加胃空肠侧侧吻合	30	NRCT	Nd	3.3	11.7	Nd
张彦林李国胜等	2.肝(胆)总管空肠Roux-Y吻合	29	NRCT	Nd	6.9	5.1	Nd
Blievernicht SW etal	biliary bypass with prophylactic	51	NRCT	45.1	Nd	5	11.7
Blievernicht SW etal	gastrojejunostomybiliary bypass	42	NRCT	26.2	Nd	6	30.9
Hehl AJ	1.a single biliary and prophy-lactically gastrojejunostomy	34	NRCT	19.6	Nd	Nd	0
Lindemann F etal	2.biliary decompression in Roux-Y technique	42	NRCT	26.2	Nd	Nd	30.9
Rothlin M Schobo eatl	1.ophylactic gast-Roenterostomy and h-epaticojejunostoPrmy	21	NRCT	33	14	Nd	0
Rothlin M Schobo eatl	2.hepaticojejunosto-my	18	NRCT	28	5	Nd	20
Mosdell DM,	1.Biliary bypass and GE	26	NRCT	35	19	Nd	0
Kessler eatl	2.Biliary bypass	27	NRCT	37	22	Nd	5
Roost HM	1.bilioeateric divers-ion and prophylacticgastroenterostomy	20	NRCT	25	5	Nd	0
Ackermanm C eatl	2.bilioeateric divers-ion	52	NRCT	50	19	Nd	14
La ferlaG MurRay	1.Biliary diversion and prophylacticgastroenterostomy	14	NRCT	Nd	14.3	Nd	0
WR eatl	2.Biliary diversion	86	NRCT	Nd	27.9	Nd	13
Vander SchelliNG	1.biliary bypass with prophylactic gastrojej-unostomy	31	NRCT	9	41	Nd	12.9
Vanden Bosch Rpiel eatl	2.biliary bypass	98	NRCT	11	33	Nd	15.3
Holbrook AG	1.prophylactic gastro-jejunostomy and biliary bypass	30	NRCT	Nd	27	7.8	0
Chester JF eatl	2.biliary bypass	128	NRCT	ND	14	7.8	9
WilliamA Zamboni eatl	1.biliary bypass and gastric bypass	14	NRCT	43	14	Nd	0
WilliamA Zamboni eatl	2.biliary bypass	30	NRCT	26	13	Nd	6.7
Wongsuw anporn	1.biliary bypass and gastrojejunostomy	26	NRCT	Nd	11.5	9.90	7.7
T BasseF eatl	2.biliary bypass	40	NRCT	Nd	12.5	6.69	17
李强王殿昌	1.胆肠内引流加预防性胃肠短路	38	NRCT	39	18	5.5	6
李强王殿昌	2.单纯胆肠内引流	49	NRCT	22	16	6.0	41
李炎宁李定明	1.肝(胆)总管空肠Roux-en-Y 吻合加胃空肠吻合	83	NRCT	Nd	6.2	14.3	0
李炎宁李定明	2.肝(胆)总管空肠Roux-en-Y 吻合	70	NRCT	Nd	5.7	10.5	31

作者	手术方式	病例数	样本设计	并发症发生率(%)	手术死亡率(%)	术后平均生存期(月)	术后十二指肠梗阻发生率(%)
Van Heek,	1.Hepaticojejunosto-my and retrocolic gastrojejunostomy	36	RCT	31	30	7.2	5.5
N Tjarda MD eta	2.Hepaticojejunosto-my	29	RCT	28	30	8.4	41.4
Lillemoe,Keith.	1.Hepaticojejunosto-my and retrocolic gastrojejunostomy	44	RCT	32	Nd	8.3	0
MD etal	2.Hepaticojejunostomy	43	RCT	33	Nd	8.3	19
张建军杨信太等	1.胆肠,预防性胃肠“h”型双吻合	18	RCT	Nd	Nd	11.68±1.02	0
张建军杨信太等	2.胆肠吻合	16	RCT	Nd	Nd	9.47±1.33	36.6
李海民窦科峰等	1.胆肠,预防性胃肠双吻合	41	NRCT	Nd	9.8	9.78±1.26	Nd
李海民窦科峰等	2.单纯胆肠内引流	67	NRCT	Nd	9.0	9.08±1.21	32.7
刘玉斌区金锐等	1.胆肠吻合加胃空肠吻合	61	NRCT	Nd	4.9	13.9	0
刘玉斌区金锐等	2.单纯肝(胆)总管空肠吻合术	53	NRCT	Nd	5.7	10.3	31.8
张彦林李国胜等	1.肝(胆)总管空肠Roux-y吻合加胃空肠侧侧吻合	30	NRCT	Nd	3.3	11.7	Nd
张彦林李国胜等	2.肝(胆)总管空肠Roux-Y吻合	29	NRCT	Nd	6.9	5.1	Nd
Blievernicht SW etal	biliary bypass with prophylactic	51	NRCT	45.1	Nd	5	11.7
Blievernicht SW etal	gastrojejunostomybiliary bypass	42	NRCT	26.2	Nd	6	30.9
Hehl AJ	1.a single biliary and prophy-lactically gastrojejunostomy	34	NRCT	19.6	Nd	Nd	0
Lindemann F etal	2.biliary decompression in Roux-Y technique	42	NRCT	26.2	Nd	Nd	30.9
Rothlin M Schobo eatl	1.ophylactic gast-Roenterostomy and h-epaticojejunostoPrmy	21	NRCT	33	14	Nd	0
Rothlin M Schobo eatl	2.hepaticojejunosto-my	18	NRCT	28	5	Nd	20
Mosdell DM,	1.Biliary bypass and GE	26	NRCT	35	19	Nd	0
Kessler eatl	2.Biliary bypass	27	NRCT	37	22	Nd	5
Roost HM	1.bilioeateric divers-ion and prophylacticgastroenterostomy	20	NRCT	25	5	Nd	0
Ackermanm C eatl	2.bilioeateric divers-ion	52	NRCT	50	19	Nd	14
La ferlaG MurRay	1.Biliary diversion and prophylacticgastroenterostomy	14	NRCT	Nd	14.3	Nd	0
WR eatl	2.Biliary diversion	86	NRCT	Nd	27.9	Nd	13
Vander SchelliNG	1.biliary bypass with prophylactic gastrojej-unostomy	31	NRCT	9	41	Nd	12.9
Vanden Bosch Rpiel eatl	2.biliary bypass	98	NRCT	11	33	Nd	15.3
Holbrook AG	1.prophylactic gastro-jejunostomy and biliary bypass	30	NRCT	Nd	27	7.8	0
Chester JF eatl	2.biliary bypass	128	NRCT	ND	14	7.8	9
WilliamA Zamboni eatl	1.biliary bypass and gastric bypass	14	NRCT	43	14	Nd	0
WilliamA Zamboni eatl	2.biliary bypass	30	NRCT	26	13	Nd	6.7
Wongsuw anporn	1.biliary bypass and gastrojejunostomy	26	NRCT	Nd	11.5	9.90	7.7
T BasseF eatl	2.biliary bypass	40	NRCT	Nd	12.5	6.69	17
李强王殿昌	1.胆肠内引流加预防性胃肠短路	38	NRCT	39	18	5.5	6
李强王殿昌	2.单纯胆肠内引流	49	NRCT	22	16	6.0	41
李炎宁李定明	1.肝(胆)总管空肠Roux-en-Y 吻合加胃空肠吻合	83	NRCT	Nd	6.2	14.3	0
李炎宁李定明	2.肝(胆)总管空肠Roux-en-Y 吻合	70	NRCT	Nd	5.7	10.5	31

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