title: Prospective randomized trial of the effect of octreotide on pancreatic juice output after pancreaticoduodenectomy in relation to histological diagnosis, duct size and leakage.
abstract: BACKGROUND
  Octreotide is generally administered based on the surgeon's interpretation of perceived risk for pancreatic fistula at the time of pancreaticoduodenectomy (PD).
  
  
  METHODS
  A single-institution, prospective randomized trial was conducted between April 2009 and December 2011 involving 62 PD patients who were randomized to receive octreotide (100 μg subcutaneously every 8 h; n = 32) or placebo (n = 30). Pancreatic juice output was measured after the operation using a catheter inserted into the pancreatic duct. Postoperative complications were recorded.
  
  
  RESULTS
  No significant differences in median output were found between the octreotide (82.5 ml) and placebo (77.5 ml) groups (P = 0.538). Median total output was significantly lower in patients with adenocarcinoma compared with those with periampullary tumours (P = 0.004) and in patients with a duct diameter of >5 mm compared with those with a duct diameter of <5 mm (P = 0.001). There were no significant differences in overall morbidity between the octreotide and placebo groups (P = 0.819). Grade B pancreatic fistula (International Study Group for Pancreatic Fistula) was observed in two and three patients in the octreotide and placebo groups, respectively.
  
  
  CONCLUSIONS
  Morbidity did not differ significantly between the groups. This study did not demonstrate an inhibitory effect of octreotide on exocrine pancreatic secretion. Based on these results, the routine use of octreotide after PD cannot be recommended.
authors.affiliation: Department of Surgery, Clinic Hospital of Barcelona, Clinical Institute for Digestive and Metabolic Diseases (Institut Clínic de Malalties Digestives i Metabòliques), Barcelona, Spain. lfcruz@clinic.ub.es
authors.forename: Laureano
authors.initials: L
authors.lastname: Fernández-Cruz
authors.forename: Enrique
authors.initials: E
authors.lastname: Jiménez Chavarría
authors.forename: Pilar
authors.initials: P
authors.lastname: Taurà
authors.forename: Daniel
authors.initials: D
authors.lastname: Closa
authors.forename: Miguel-Angel López
authors.initials: MA
authors.lastname: Boado
authors.forename: Joana
authors.initials: J
authors.lastname: Ferrer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000627:therapeutic use*; D010185:Pancreatic Fistula / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D010189:Pancreatic Juice; D010190:Pancreatic Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D005765:Gastrointestinal Agents; D015282:Octreotide
references.citation: Arch Surg. 1995 Mar;130(3):295-9; discussion 299-300
references.pmid: 7887797
references.citation: Surgery. 1996 Mar;119(3):281-7
references.pmid: 8619183
references.citation: J Am Coll Surg. 2009 May;208(5):738-47; discussion 747-9
references.pmid: 19476827
references.citation: J Gastrointest Surg. 2008 Jan;12(1):51-6
references.pmid: 17955317
references.citation: Arch Surg. 2001 Apr;136(4):391-8
references.pmid: 11296108
references.citation: World J Surg. 2008 Mar;32(3):419-28
references.pmid: 18175170
references.citation: Am J Surg. 1992 Jan;163(1):125-30; discussion 130-1
references.pmid: 1733360
references.citation: Arch Surg. 2004 Mar;139(3):288-94; discussion 295
references.pmid: 15006886
references.citation: J Nippon Med Sch. 2002 Dec;69(6):549-56
references.pmid: 12646987
references.citation: HPB (Oxford). 2010 Apr;12(3):155-65
references.pmid: 20590882
references.citation: Br J Surg. 2012 Apr;99(4):524-31
references.pmid: 22497024
references.citation: Ann Surg. 2006 Jul;244(1):10-5
references.pmid: 16794383
references.citation: J Am Coll Surg. 2007 Oct;205(4):546-57
references.pmid: 17903728
references.citation: Chirurg. 1979 Jul;50(7):427-31
references.pmid: 477469
references.citation: Br J Surg. 2005 Sep;92(9):1059-67
references.pmid: 16044410
references.citation: Acta Chir Belg. 2005 Aug;105(4):383-7
references.pmid: 16184721
references.citation: Hepatogastroenterology. 2002 Mar-Apr;49(44):553-5
references.pmid: 11995494
references.citation: J Am Coll Surg. 2003 Apr;196(4):556-64; discussion 564-5; author reply 565
references.pmid: 12691930
references.citation: Digestion. 1987;36(2):108-24
references.pmid: 2883060
references.citation: Surgery. 2005 Jul;138(1):8-13
references.pmid: 16003309
references.citation: Arch Surg. 2008 May;143(5):476-81
references.pmid: 18490557
references.citation: Can J Surg. 2007 Dec;50(6):459-66
references.pmid: 18053374
references.citation: HPB (Oxford). 2010 Dec;12(10):696-702
references.pmid: 21083795
references.citation: World J Surg. 2009 Dec;33(12):2670-8
references.pmid: 19774410
references.citation: Br J Surg. 2001 Feb;88(2):190-9
references.pmid: 11167865
references.citation: J Gastrointest Surg. 2007 Nov;11(11):1451-8; discussion 1459
references.pmid: 17710506
references.citation: Cochrane Database Syst Rev. 2010 Feb 17;(2):CD008370
references.pmid: 20166101
references.citation: Ann Surg. 1997 Nov;226(5):632-41
references.pmid: 9389397
references.citation: Br J Surg. 2001 Nov;88(11):1456-62
references.pmid: 11683740
references.citation: Am Surg. 2004 Mar;70(3):222-6; discussion 227
references.pmid: 15055845
references.citation: Gut. 1994;35(3 Suppl):S1-4
references.pmid: 7911441
references.citation: J Gastrointest Surg. 2004 Dec;8(8):951-9
references.pmid: 15585382
references.citation: J Hepatobiliary Pancreat Sci. 2011 Nov;18(6):762-8
references.pmid: 21912837
references.citation: Ann Surg. 2000 Sep;232(3):419-29
references.pmid: 10973392
references.citation: Br J Surg. 1995 Sep;82(9):1270-3
references.pmid: 7552016
references.citation: Surgery. 1998 Nov;124(5):871-6
references.pmid: 9823401
references.citation: Ann Surg. 1997 Sep;226(3):248-57; discussion 257-60
references.pmid: 9339931
references.citation: J Gastrointest Surg. 2006 Nov;10(9):1225-9
references.pmid: 17114009
references.citation: Pancreas. 2008 Jan;36(1):18-25
references.pmid: 18192875
references.citation: World J Surg. 2003 Jun;27(6):709-14
references.pmid: 12732998
references.citation: Br J Surg. 1994 Feb;81(2):265-9
references.pmid: 8156354
references.citation: Ann Surg. 2008 Dec;248(6):930-8
references.pmid: 19092337
references.citation: Hepatogastroenterology. 2006 Sep-Oct;53(71):788-91
references.pmid: 17086890
references.citation: J Gastrointest Surg. 2009 Jan;13(1):163-73
references.pmid: 18496727
references.citation: Am J Surg. 1998 Sep;176(3):270-3
references.pmid: 9776157
references.citation: Surgery. 1995 Jan;117(1):26-31
references.pmid: 7809832