Stomach-partitioning gastrojejunostomy is better than conventional gastrojejunostomy in palliative care of gastric outlet obstruction for gastric or pancreatic cancer: a meta-analysis

Background: Unresectable gastric or pancreatic malignancies are the most common cause of gastric outlet obstruction (GOO). Although several authors reported better outcomes in patients submitted to gastric partitioning gastrojejunostomy (GPGJ) compared to conventional gastrojejunostomy (CGJ), clinical experience with GPGJ is poor, studies comparing the two techniques are few and no randomized trials were performed. Our systematic review aimed at comparing GPGJ (partial or complete) with CGJ in patients operated for GOO for gastric or pancreatic cancer. Methods: A computerized literature search was performed on Medline until January 2017. The studies included were 8 with a total of 226 patients. Study outcomes included delayed gastric emptying (DGE), nutrition by oral intake, length of hospital stay and survival time. The pooled effects were estimated using a fixed effect model or random effect model based on the heterogeneity test. Results were expressed as odds ratio (OR) and 95% confidence interval (CI) for dichotomous outcomes. For continuous outcomes, the mean of the measures of central tendency was calculated. Results: The GPGJ group had lower rates of DGE (OR = 4.997, 95% CI: 2.310-10.810) and length of hospital stay (19.7 versus 23.3 days) and higher rates of nutrition by oral intake (OR = 0.156, 95% CI: 0.0550.442) and survival time (189.2 versus 115.2 days). Conclusions: GPGJ is associated with lower rates of DGE and higher rates of normal oral intake compared to CGJ with a tendency towards better survival in the GPGJ group. Multicenter randomized controlled trials would be required to confirm these results.