title: Prophylactic gastrojejunostomy for unresectable periampullary carcinoma.
abstract: BACKGROUND
  The role of prophylactic gastrojejunostomy in patients with unresectable periampullary cancer is controversial.
  
  
  OBJECTIVE
  To determine whether prophylactic gastrojejunostomy should be performed routinely in patients with unresectable periampullary cancer.
  
  
  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.
  
  
  METHODS
  We included randomised controlled trials comparing prophylactic gastrojejunostomy versus no gastrojejunostomy in patients with unresectable periampullary cancer (irrespective of language or publication status).
  
  
  METHODS
  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.
  
  
  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).
  
  
  CONCLUSIONS
  Routine prophylactic gastrojejunostomy is indicated in patients with unresectable periampullary cancer undergoing exploratory laparotomy (with or without hepaticojejunostomy).
authors: Department of Surgery, Royal Free Campus, UCLMedical School, London, UK. kurinchi2k@hotmail.com.
authors: Kurinchi Selvan
authors: KS
authors: Gurusamy
authors: Senthil
authors: S
authors: Kumar
authors: Brian R
authors: BR
authors: Davidson
mesh_terms: D014670:Ampulla of Vater / Q000601:surgery*; D003138:Common Bile Duct Neoplasms / Q000601:surgery*; D015390:Gastric Bypass / Q000379:methods* / Q000401:mortality; D017219:Gastric Outlet Obstruction / Q000517:prevention & control; D006801:Humans; D007565:Jaundice / Q000517:prevention & control / Q000601:surgery; D007902:Length of Stay; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic