Randomized controlled multicentre trial of somatostatin infusion after pancreaticoduodenectomy.
BACKGROUND
It remains debatable whether somatostatin can prevent pancreatic fistula and other pancreatic stump-related complications following pancreaticoduodenectomy. This study assessed the effects of somatostatin-14 (S-14) on pancreatic remnant exocrine secretion.


METHODS
This was a double-blind, randomized, placebo-controlled trial in patients undergoing pancreaticoduodenectomy for malignancy. Patients received a continuous infusion of S-14 (n = 38) or placebo (n = 37) for 7 days. Pancreatic juice and peripancreatic drainage fluid was collected and measured, and pancreatic enzymes were monitored daily. Postoperative complications were recorded.


RESULTS
S-14 infusion was associated with a decrease in median daily pancreatic juice and pancreatic amylase output. Amylase concentration and output in the peripancreatic drain fluid were significantly lower after S-14 infusion than in the control group (both P < 0.05). The incidence of clinical pancreatic fistula (two of 38 versus eight of 37; P < 0.05) and total pancreatic stump-related complications (five of 38 versus 12 of 37; P < 0.05) was lower in patients treated with S-14. Duration of hospital stay was shorter after S-14 (18 versus 26 days; P = 0.01).


CONCLUSIONS
Although the effect of S-14 on exocrine secretion remains difficult to demonstrate, it did reduce pancreatic juice leakage from the pancreatic remnant.
Gouillat
C
C
Department of Surgery, Hôtel Dieu, Bordeaux, France. christian.gouillat@chu-lyon.fr
Chipponi
J
J
Baulieux
J
J
Partensky
C
C
Saric
J
J
Gayet
B
B
D000293:Adolescent; D000328:Adult; D000368:Aged; D000681:Amylases / Q000378:metabolism; D004311:Double-Blind Method; D004379:Duodenal Neoplasms / Q000601:surgery; D005260:Female; D006728:Hormones / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous; D008049:Lipase / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000201:enzymology; D010189:Pancreatic Juice / Q000378:metabolism; D010190:Pancreatic Neoplasms / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011182:Postoperative Care / Q000379:methods; D013004:Somatostatin / Q000008:administration & dosage*
D006728:Hormones; D013004:Somatostatin; D008049:Lipase; D000681:Amylases