Abstract：
Gastrojejunostomy (GJ) is becoming a standard surgical treatment for ameliorating malignant gastric outlet obstruction (MGOO). However, data on the long-term outcomes of MGOO treatment are lacking. This network meta-analysis aimed to compare overall survival (OS) rates and subsequent anticancer treatment outcomes of GJwith other therapies in MGOO.
We searched four electronic databases, including PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials, from inception to August 1, 2022. Studies reporting OS associated with GJ versus other treatments for MGOO were selected. The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The primary outcome assessed was OS, whereas the secondary outcome was subsequent anticancer treatment. We performed a Bayesian network meta-analysis to produce hazard ratios (HR) and odds ratios (OR) with 95% credible intervals (CrIs).
We identified 24 retrospective studies that included 2473 patients. The studies assessed the outcomes of six treatments to alleviate MGOO. Results showed that GJ (hazard ratio: 0.83, 95% CrI: 0.78-0.88) was the most effective treatment for patients with MGOO, with the greatest surface under the cumulative ranking curve (SUCRA) values (79.9%) versus non-resection, palliative chemotherapy (13.9%) in terms of OS. Similarly, GJ (SUCRA: 46.5%) improved subsequent anticancer treatment requirements, ranking second only to jejunostomy/gastrostomy (JT/GT) (SUCRA: 95.9%).
Our study demonstrates that GJ improves OS and follow-up treatments versus other non-resection treatments in patients with MGOO. These findings may serve for selecting appropriate therapy for MGOO.
We searched four electronic databases, including PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials, from inception to August 1, 2022. Studies reporting OS associated with GJ versus other treatments for MGOO were selected. The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The primary outcome assessed was OS, whereas the secondary outcome was subsequent anticancer treatment. We performed a Bayesian network meta-analysis to produce hazard ratios (HR) and odds ratios (OR) with 95% credible intervals (CrIs).
We identified 24 retrospective studies that included 2473 patients. The studies assessed the outcomes of six treatments to alleviate MGOO. Results showed that GJ (hazard ratio: 0.83, 95% CrI: 0.78-0.88) was the most effective treatment for patients with MGOO, with the greatest surface under the cumulative ranking curve (SUCRA) values (79.9%) versus non-resection, palliative chemotherapy (13.9%) in terms of OS. Similarly, GJ (SUCRA: 46.5%) improved subsequent anticancer treatment requirements, ranking second only to jejunostomy/gastrostomy (JT/GT) (SUCRA: 95.9%).
Our study demonstrates that GJ improves OS and follow-up treatments versus other non-resection treatments in patients with MGOO. These findings may serve for selecting appropriate therapy for MGOO.
摘要：
背景：胃空肠造口术（GJ）正在成为改善恶性胃出口梗阻（MGOO）的标准外科治疗方法。然而,缺乏有关MGOO治疗的长期结果的数据。此网络荟萃分析旨在比较MGOO中GJ与其他疗法的总体生存率（OS）和随后的抗癌治疗结果。
方法：我们搜索了四个电子数据库，包括PubMed,Embase,WebofScience,和Cochrane中央控制试验登记册，从成立到2022年8月1日。选择报告与GJ相关的OS与MGOO的其他治疗相比的研究。该研究是根据系统评价和荟萃分析（PRISMA）指南的首选报告项目进行的。评估的主要结果是OS，而次要结果是随后的抗癌治疗。我们进行了贝叶斯网络荟萃分析，以产生具有95％可信间隔（CrIs）的风险比（HR）和比值比（OR）。
结果：我们确定了24项回顾性研究，包括2473例患者。这些研究评估了六种缓解MGOO的治疗方法的结果。结果表明，GJ（风险比：0.83，95％CrI：0.78-0.88）是MGOO患者最有效的治疗方法，与最大表面下的累积排序曲线（SUCRA）值（79.9％）与非切除，姑息性化疗（13.9%）的OS。同样，GJ（SUCRA：46.5％）提高了随后的抗癌治疗要求，仅次于空肠造口术/胃造口术（JT/GT）（SUCRA：95.9%）。
结论：我们的研究表明，与其他非切除治疗相比，GJ改善了MGOO患者的OS和后续治疗。这些发现可能有助于为MGOO选择合适的治疗方法。
方法：我们搜索了四个电子数据库，包括PubMed,Embase,WebofScience,和Cochrane中央控制试验登记册，从成立到2022年8月1日。选择报告与GJ相关的OS与MGOO的其他治疗相比的研究。该研究是根据系统评价和荟萃分析（PRISMA）指南的首选报告项目进行的。评估的主要结果是OS，而次要结果是随后的抗癌治疗。我们进行了贝叶斯网络荟萃分析，以产生具有95％可信间隔（CrIs）的风险比（HR）和比值比（OR）。
结果：我们确定了24项回顾性研究，包括2473例患者。这些研究评估了六种缓解MGOO的治疗方法的结果。结果表明，GJ（风险比：0.83，95％CrI：0.78-0.88）是MGOO患者最有效的治疗方法，与最大表面下的累积排序曲线（SUCRA）值（79.9％）与非切除，姑息性化疗（13.9%）的OS。同样，GJ（SUCRA：46.5％）提高了随后的抗癌治疗要求，仅次于空肠造口术/胃造口术（JT/GT）（SUCRA：95.9%）。
结论：我们的研究表明，与其他非切除治疗相比，GJ改善了MGOO患者的OS和后续治疗。这些发现可能有助于为MGOO选择合适的治疗方法。
