title: Effect of antecolic or retrocolic route of gastroenteric anastomosis on delayed gastric emptying after pancreaticoduodenectomy: A meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  Delayed gastric emptying (DGE) is one of the most troublesome complications after classical pancreaticoduodenectomy (PD) or pylorus-preserving PD. Whether the route of gastroenteric reconstruction has any influence on DGE remains controversial. The aim of this study was to investigate the influence of different types of gastroenteric anastomosis on DGE after PD/PPPD.
  
  
  METHODS
  A systematic search of literature databases (Cochrane Library, PubMed, EMBASE, and Web of Science) was performed to identify eligible studies. Cochrane collaboration's tool for assessing risk of bias was utilized to evaluate the quality of included studies. The primary outcome was DGE incidence rate. Further outcomes included mortality, morbidity, and other operation related events. Random-effect or fix-effect models were used as appropriate.
  
  
  RESULTS
  Five randomized controlled trials (RCTs) including a total of 530 patients were identified and included in the analysis. Based on these studies, no difference was found in DGE incidence between antecolic and retrocolic groups (relative risk [RR], 0.82; 95% confidence interval [CI], 0.51-1.32; P = 0.41). Mortality, morbidity, and operation related events were not significantly different between groups.
  
  
  CONCLUSIONS
  Results of the meta-analysis reveal that DGE occurrence is not affected by route of gastroenteric anastomosis. Anastomosis approach should be chosen according to the surgeons' preference.
authors.affiliation: Pancreas Center, Department of General Surgery, the First Affiliated Hospital With Nanjing Medical University, Nanjing, China.
authors.forename: Dong
authors.initials: D
authors.lastname: Qian
authors.affiliation: Pancreas Center, Department of General Surgery, the First Affiliated Hospital With Nanjing Medical University, Nanjing, China.
authors.forename: Zipeng
authors.initials: Z
authors.lastname: Lu
authors.affiliation: Cancer Research UK Liverpool Cancer Trials Unit, University of Liverpool, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Jackson
authors.affiliation: Pancreas Center, Department of General Surgery, the First Affiliated Hospital With Nanjing Medical University, Nanjing, China.
authors.forename: Junli
authors.initials: J
authors.lastname: Wu
authors.affiliation: Pancreas Center, Department of General Surgery, the First Affiliated Hospital With Nanjing Medical University, Nanjing, China.
authors.forename: Xinchun
authors.initials: X
authors.lastname: Liu
authors.affiliation: Pancreas Center, Department of General Surgery, the First Affiliated Hospital With Nanjing Medical University, Nanjing, China.
authors.forename: Baobao
authors.initials: B
authors.lastname: Cai
authors.affiliation: Pancreas Center, Department of General Surgery, the First Affiliated Hospital With Nanjing Medical University, Nanjing, China.
authors.forename: Pengfei
authors.initials: P
authors.lastname: Wu
authors.affiliation: Pancreas Center, Department of General Surgery, the First Affiliated Hospital With Nanjing Medical University, Nanjing, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Yin
authors.affiliation: Pancreas Center, Department of General Surgery, the First Affiliated Hospital With Nanjing Medical University, Nanjing, China.
authors.forename: Qingcheng
authors.initials: Q
authors.lastname: Xu
authors.affiliation: Pancreas Center, Department of General Surgery, the First Affiliated Hospital With Nanjing Medical University, Nanjing, China.
authors.forename: Dong
authors.initials: D
authors.lastname: Xu
authors.affiliation: Pancreas Center, Department of General Surgery, the First Affiliated Hospital With Nanjing Medical University, Nanjing, China.
authors.forename: Yunpeng
authors.initials: Y
authors.lastname: Peng
authors.affiliation: Pancreas Center, Department of General Surgery, the First Affiliated Hospital With Nanjing Medical University, Nanjing, China. Electronic address: jiangkuirong@njmu.edu.cn.
authors.forename: Kuirong
authors.initials: K
authors.lastname: Jiang
authors.affiliation: Pancreas Center, Department of General Surgery, the First Affiliated Hospital With Nanjing Medical University, Nanjing, China. Electronic address: miaoyi@njmu.edu.cn.
authors.forename: Yi
authors.initials: Y
authors.lastname: Miao
mesh_terms: D005763:Gastroenterostomy / Q000379:methods; D018589:Gastroparesis / Q000209:etiology*; D006801:Humans; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology*; D012307:Risk Factors
keywords: Antecolic; Delayed gastric emptying; Gastroenteric anastomosis route; Meta-analysis; Pancreaticoduodenectomy; Retrocolic