Somatostatin analogues in the prevention of pancreas-related complications after pancreatic resection.
OBJECTIVE
The Achilles' heel of operative pancreatectomies is the pancreaticoenterostomy for proximal resections and the pancreatic parenchymal closure for distal resections. Inhibition of pancreatic exocrine secretions by somatostatin analogues has been suggested to decrease pancreas-specific complications, but this topic remains controversial.


METHODS
We performed a randomized, prospective, placebo-controlled, multicenter trial of the use of perioperative vapreotide, a potent somatostatin analogue, in pancreatic resections for presumed neoplasms in 381 patients without chronic pancreatitis. We also reviewed the literature on the use of somatostatin and its analogues after pancreatectomy.


RESULTS
When compared to the placebo, perioperative vapreotide had no effect on overall pancreas-specific complications (30.4% vs 26.4%), mortality (0% vs 1.4%), overall complications (40% vs 42%), and duration of hospitalization; there were no differences in complications per type of resection with use of vapreotide--proximal versus distal resection. Seven other prospective, randomized trials provide differing results.


CONCLUSIONS
Our study with vapreotide failed to show any benefit when administered perioperatively (and for 7 days postoperatively) on pancreas-specific complications after major pancreatectomy in patients without chronic pancreatitis. The use of perioperative analogues that suppress pancreatic exocrine secretion seems not to be warranted as routine treatment.
Ramos-De la Medina
Antonio
A
Department of Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA.
Sarr
Michael G
MG
D000328:Adult; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D046790:Pancreas, Exocrine / Q000187:drug effects / Q000378:metabolism; D010180:Pancreatectomy; D010185:Pancreatic Fistula / Q000517:prevention & control*; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D013004:Somatostatin / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use
D005765:Gastrointestinal Agents; C051458:vapreotide; D013004:Somatostatin