Prophylactic gastrojejunostomy for unresectable periampullary carcinoma

Routine prophylactic gastrojejunostomy may reduce gastric outlet obstruction in patients with unresectable periampullary cancer undergoing exploratory laparotomy.

The quality of evidence is downgraded by imprecise results (only few small trials reported and limited study size for each comparison).

Summary

A Cochrane review included two RCTs with a total of 152 patients to determine whether prophylactic gastrojejunostomy should be performed routinely in patients with unresectable periampullary cancer.

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 patients who underwent prophylactic gastrojejunostomy and those who did not. However, the prophylactic gastrojejunostomy group developed long term gastric outlet obstruction significantly less often (2/80; 2.5%) compared with no gastrojejunostomy group (20/72; 27.8%) (RR 0.10; 95%CI 0.03 to 0.37).

Clinical comments

Date of latest search:

Ədəbiyyat

1. Gurusamy KS, Kumar S, Davidson BR. Prophylactic gastrojejunostomy for unresectable periampullary carcinoma. Cochrane Database Syst Rev 2013;2():CD008533.