Efficacy of cholecystojejunostomy and choledochoenterostomy for obstructive jaundice caused by unresectable pancreatic head carcinoma: a meta-analysis

Abstract

Objective To investigate the efficacy of cholecystoenterostomy (CCE) and choledochoenterostomy (CDE) for obstructive jaundice caused by unresectable pancreatic head carcinoma. Methods Literature from the Cochrane, PubMed, EMBASE, Ovid, Springer, CNKI, WANFANG, VIP databases between January 1980 and January 2016 was searched. The search terms were pancreatic cancer, pancreatic neoplasms, pancreatic tumor, cholecystoenterostomy, choledochoenterostomy, biliary bypass and palliative surgery, both in Chinese and English. The patients from the literature were divided into the CCE group and CDE group. The outcome indicators including recurrence rate of jaundice, perioperative mortality and incidence of postoperative complications in two groups were analyzed using the Meta-analysis. Results A total of 12 literatures were included after screening, including two reports of random controlled trials and 10 retrospective studies. The meta-analysis results revealed that the recurrence rate of jaundice in the CCE group was significantly higher than that in the CDE group (OR=5.00, 95%CI: 3.12-8.03; P<0.05). The median survival time in the CCE group was significantly shorter than that in the CDE group (SMD=-1.96, 95%CI: -2.30 - -1.62; P<0.05). The perioperative mortality in the CCE group was significantly higher than that in the CDE group (OR=1.90, 95%CI:1.56- 2.23; P<0.05). Conclusion Compared with CCE, CDE has the advantages of lower recurrence rate of jaundice, lower perioperative mortality and longer survival time in treating obstrucive jaundice caused by unresectable pancreatic head carcinoma. Key words: Pancreatic neoplasms; Jaundice,obstructive; Cholecystoenterostomy; Choledochoenterostomy; Meta-analysis