Introduction
Gastric outlet obstruction (GOO) is a severe complication of unresectable gastric and pancreatic cancers. Conventional gastrojejunostomy (CGJ) is a standard surgical intervention, but it is associated with a high incidence of delayed gastric emptying (DGE). Stomach-partitioning gastrojejunostomy (SPGJ) has emerged as an alternative to improve gastric emptying and enhance clinical outcomes.
Aims & Methods
We conducted a meta-analysis comparing SPGJ and CGJ in patients with GOO due to unresectable gastric or pancreatic cancers. Electronic databases were searched up to February 8, 2025. Outcomes included DGE, major postoperative complications, need for reintervention, short-term mortality, operation time, gastric outlet obstruction scoring system (GOOS), length of hospital stay (LOS), adherence to postoperative chemotherapy, and overall survival. For continuous outcomes, mean differences (MD) with 95% confidence intervals (CI) were calculated. For dichotomous outcomes, relative risks (RR) with 95% CI were reported. Reconstructed individual patient data (IPD) from Kaplan-Meier curves was utilized for survival analysis.
Results
A total of 11 studies comprising 456 patients were included. SPGJ was associated with significantly reduced DGE (RR = 0.24, 95% CI: 0.12–0.47) and postoperative major complications (RR = 0.26, 95% CI: 0.12–0.54) compared to CGJ. No significant differences were found in the need for reintervention (RR = 0.59, 95% CI: 0.21–1.64), short-term mortality (RR = 0.99, 95% CI: 0.42–2.33), or LOS (MD = -1.47 days, 95% CI: -3.10 to 0.16). GOOS scores were comparable between groups. Overall survival was also similar between SPGJ and CGJ (HR = 1.06, 95% CI: 0.66–1.70).
Conclusion
Our meta-analysis supports SPGJ as a superior option to CGJ for managing malignant GOO, offering significant reductions in DGE and postoperative complications, similar GOOS scores, and comparable safety regarding reintervention, short-term and long-term mortality, and LOS. High-quality RCTs are needed to confirm these findings and guide clinical practice.
References
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