title: A prospective study of prophylactic long-acting octreotide in high-risk patients undergoing pancreaticoduodenectomy.
abstract: BACKGROUND
  Postoperative pancreatic fistula (postoperative pancreatic fistula [POPF]) is the most common complication after pancreaticoduodenectomy. Despite some studies showing little effect of octreotide in unselected patients, we hypothesized that in high-risk patients depot octreotide may reduce the risk of POPF.
  
  
  METHODS
  Sixty-eight patients were prospectively evaluated for inclusion in the current study. Two groups were identified: pancreatic ducts ≤3 mm (high risk) and those with ducts >3 mm (low risk). Thirty-two patients were low risk, whereas 36 patients were high risk. High-risk patients were treated preoperatively with depot octreotide and begun on an intravenous drip for 24 hours. Low-risk patients underwent pancreaticoduodenectomy without pharmacologic intervention. In contrast, the control cohort represents 106 retrospectively analyzed patients who underwent a pancreaticoduodenectomy without depot octreotide injection without regard to low- or high-risk status.
  
  
  RESULTS
  Overall, POPF was 11 of 68 (16%). Nine of 36 high risk patients treated with depot octreotide developed POPF (25%), and 2 of 32 low risk patients developed POPF (6%). In the control cohort of high-risk patients, 9 of 44 (20%) and 3 of 62 (5%) low-risk patients developed POPF (P = .628 when comparing the development of POPF in high-risk patients with or without pharmacologic intervention).
  
  
  CONCLUSIONS
  Prophylactic use of depot octreotide in high-risk patients does not result in reduced incidence of POPF. Duct size has a significant impact on the occurrence of POPF.
authors.affiliation: Department of Surgery, Georgetown University, Washington, DC 20007, USA.
authors.forename: Jay A
authors.initials: JA
authors.lastname: Graham
authors.forename: Lynt B
authors.initials: LB
authors.lastname: Johnson
authors.forename: Naddim
authors.initials: N
authors.lastname: Haddad
authors.forename: Firas
authors.initials: F
authors.lastname: Al-Kawas
authors.forename: John
authors.initials: J
authors.lastname: Carroll
authors.forename: Reena
authors.initials: R
authors.lastname: Jha
authors.forename: Jason
authors.initials: J
authors.lastname: Wong
authors.forename: Dana
authors.initials: D
authors.lastname: Maglaris
authors.forename: Shea
authors.initials: S
authors.lastname: Mertens
authors.forename: Thomas
authors.initials: T
authors.lastname: Fishbein
mesh_terms: D003692:Delayed-Action Preparations / Q000627:therapeutic use; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D015282:Octreotide / Q000627:therapeutic use*; D010185:Pancreatic Fistula / Q000453:epidemiology / Q000517:prevention & control*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D011292:Premedication; D011446:Prospective Studies; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome
chemical_list: D003692:Delayed-Action Preparations; D005765:Gastrointestinal Agents; D015282:Octreotide