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Clinical Summary

Does prophylactic somatostatin therapy improve outcomes following pancreaticoduodenectomy?

Takeaway

  • Prophylactic administration of somatostatin analogues (SA) following pancreaticoduodenectomy (PD) does not improve post-operative outcomes, including reducing the incidence of post-operative pancreatic fistula (POPF).
  • Routine administration of SA cannot be recommended following PD.

Why this matters

  • POPF following PD remains a major cause of morbidity and is associated with a twofold increased risk for mortality.
  • Use of hormone somatostatin or its synthetic analogues is the most commonly used method to reduce the incidence of POPF, but the published data have been conflicting.

Study designs

  • 12 randomised controlled trials involving 1615 patients (SA-treated group: n=820; and control group: n=795) met eligibility criteria after a search on EMBASE, MEDLINE and Cochrane databases.
  • SA used included somatostatin-14, pasireotide, vapreotide and octreotide.
  • Meta-analysis determined the outcome of the prophylactic use of SA on morbidity and mortality following PD.
  • Funding: None disclosed.

Results

  • Pooled data showed no significant benefit of SA for the primary outcome of all grades of POPF (OR, 0.73; 95% CI, 0.51-1.05; P=.09) and clinically relevant POPF (OR, 0.48; 95% CI, 0.22-1.06; P=.07).
  • No benefits were observed in the secondary outcomes of:
    • delayed gastric emptying (OR, 0.98; 95% CI, 0.57-1.69; P=.94);
    • infected abdominal collections (OR, 0.80; 95% CI, 0.44-1.43; P=.80);
    • reoperation rates (OR, 1.24; 95% CI, 0.73-2.13; P=.42);
    • duration of hospital stay (OR, −0.23; 95% CI, −1.59 to 1.13; P=.74) and
    • mortality (OR, 1.78; 95% CI, 0.94-3.39; P=.08).

Limitations

  • Subgroup analysis by patient characteristics, underlying pathophysiology of the pancreas gland or type of SA was not undertaken as this was not consistently reported.

References


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