Use of octreotide for the prevention of pancreatic fistula after elective pancreatic surgery: a systematic review and meta-analysis.
OBJECTIVE
To assess the effectiveness of octreotide in preventing postoperative pancreatic fistula. Pancreatic fistula is one of the most common complications after elective pancreatic surgery. Several clinical trials have evaluated the use of octreotide to prevent the development of pancreatic fistula after pancreatic surgery with conflicting recommendations.


METHODS
We undertook a meta-analysis of 7 identified randomized controlled trials, reporting comparisons between octreotide and a control. The primary outcome was the incidence of postoperative pancreatic fistula, and the secondary outcome was the postoperative mortality.


RESULTS
Seven studies, involving 1359 patients, met the inclusion criteria for this review. In these studies, sample sizes ranged from 75 to 252 patients. In total, 679 patients were given octreotide and 680 patients formed the control group. Perioperative octreotide is associated with a significant reduction in the incidence of pancreatic fistula after elective pancreatic surgery, with a relative risk of 0.59 (95% confidence interval 0.41-0.85, p = 0.004). However, this risk reduction was not associated with a significant difference in postoperative mortality (p > 0.05).


CONCLUSIONS
The review revealed that perioperative octreotide is associated with a significant reduction in the incidence of pancreatic fistula after elective pancreatic surgery. However, this risk reduction was not associated with a significant difference in postoperative mortality; further studies are warranted to confirm the results of this metaanalysis and to define which patient subgroups might benefit the most from prophylactic octreotide administration.
Department of Surgery, University of Toronto, Toronto, Ontario, Canada. Abdullah.Alghamdi@utoronto.ca
Abdullah A
AA
Alghamdi
Ali M
AM
Jawas
Richard S
RS
Hart
D000368:Aged; D017558:Elective Surgical Procedures / Q000009:adverse effects; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D015282:Octreotide / Q000627:therapeutic use*; D010180:Pancreatectomy / Q000009:adverse effects*; D010185:Pancreatic Fistula / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
D005765:Gastrointestinal Agents; D015282:Octreotide