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- Dokumenttyp:
- Journal Article; Meta-Analysis; Review; Article
- Autor(en):
- Hüser, N; Michalski, CW; Schuster, T; Friess, H; Kleeff, J
- Titel:
- Systematic review and meta-analysis of prophylactic gastroenterostomy for unresectable advanced pancreatic cancer.
- Abstract:
- BACKGROUND: The value of prophylactic gastroenterostomy (usually combined with a biliary bypass) in patients with unresectable cancer of the pancreatic head is controversial. METHODS: A systematic review of retrospective and prospective studies, and a meta-analysis of prospective studies, on the use of prophylactic gastroenterostomy for unresectable pancreatic cancer were performed. RESULTS: Analysis of retrospective studies did not reveal any advantage or disadvantage of prophylactic gastroenterostomy. Three prospective studies comparing prophylactic gastroenterostomy plus biliodigestive anastomosis with no bypass or a biliodigestive anastomosis alone were identified (altogether 218 patients). For patients who had prophylactic gastroenterostomy, the chance of gastric outlet obstruction during follow-up was significantly lower (odds ratio (OR) 0.06 (95 per cent confidence interval (c.i.) 0.02 to 0.21); P < 0.001). The rates of postoperative delayed gastric emptying were similar in both groups (OR 1.93 (95 per cent c.i. 0.57 to 6.53); P = 0.290), as were morbidity and mortality. The estimated duration of hospital stay after prophylactic gastroenterostomy was 3 days longer than for patients without bypass (weighted mean difference 3.1 (95 per cent c.i. 0.7 to 5.5); P = 0.010). CONCLUSION: Prophylactic gastroenterostomy should be performed during surgical exploration of patients with unresectable pancreatic head tumours because it reduces the incidence of long-term gastroduodenal obstruction without impairing short-term outcome.
- Zeitschriftentitel:
- Br J Surg
- Jahr:
- 2009
- Band / Volume:
- 96
- Heft / Issue:
- 7
- Seitenangaben Beitrag:
- 711-9
- Sprache:
- eng
- Volltext / DOI:
- doi:10.1002/bjs.6629
- PubMed:
- http://view.ncbi.nlm.nih.gov/pubmed/19526616
- Print-ISSN:
- 0007-1323
- TUM Einrichtung:
- Chirurgische Klinik und Poliklinik; Institut für Medizinische Statistik und Epidemiologie
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