Preventive effects of ulinastatin on complications related to pancreaticoduodenectomy

Zhang, Hao; Tan, Chunlu; Wang, Xing; Kang, Deying; Chen, Yonghua; Xiong, Junjie; Tian, Bole; Li, Kezhou; Hu, Weiming; Chen, Xiaoli; Ke, Nengwen; Li, Ang; Liu, Xuedong

doi:10.1097/md.0000000000003731

Cited by 16 publications

(5 citation statements)

References 34 publications

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“…A POPF was diagnosed in 8 of these 27 patients, 3 with Grade A, 5 with Grade B, and none with a Grade C POPF. Zhang et al, [ 75 ] proposed inactivating the pancreatic juice with an intravenous administration of ulinastatin (a potent trypsin inhibitor) immediately preoperatively and once daily for the first 5 days postoperatively. The number of B–C Grade POPF was significantly less in the ulinastatin Group (7% vs. 24%; P = .045).…”

Section: Discussionmentioning

confidence: 99%

“…In theory, use of somatostatin analogues to decrease the volume of pancreatic secretion in conjunction with a venting external drainage system with the potential for lavage of the peripancreatic area with protease inhibitors such as gabexate mesilate [ 74 ] or ulinastatin [ 75 ] could combine these concepts of decreasing the luminal pressure in the anastomotic area and evacuating and/or inhibiting the autodigestive properties of any pancreatic anastomotic leakage. Adequate prospective randomized studies are needed to examine this hypothesis.…”

Section: Discussionmentioning

confidence: 99%

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Pancreatoduodenectomy (PD) and postoperative pancreatic fistula (POPF)

Pedrazzoli¹

2017

Medicine

162

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Background:Pancreatoduodenectomy (PD) is one of the most technically demanding operations challenging surgeons, and a postoperative pancreatic fistula (POPF) can complicate an otherwise uneventful postoperative (PO) course. This review examined the methods and procedures used to prevent postoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD).Methods:A comprehensive systematic search of the literature was performed using PubMed (Medline), Embase, Web of science, and the Cochrane databases for studies published between January 1, 1990 and December 31, 2015. English language articles involving at least 100 patients undergoing PDs carried out in centers performing at least 10 PDs/y were screened for data regarding the Grade of any POPFs according to the definition of the International Study Group on Pancreatic Fistula (ISGPF) and the overall rate of PO mortality related to POPF.Results:We reviewed 7119 references through the major databases, and an additional 841 studies were identified by cross-checking the bibliographies of the full-text articles retrieved. After excluding 7379 out of 7960 studies, because they did not meet the eligibility criteria, the full texts of 581 articles were examined; 96 studies were excluded at this point, because they concerned partially or totally duplicate data that had already been reported. The remaining 485 articles were screened carefully for POPF-related mortality and POPF Grades as defined by the ISGPF. Of the 485 articles, 208 reported the POPF-related PO mortality rate and 162 the Grades (A, B, and C) of POPFs in 60,739 and 54,232 patients, respectively. The POPF-related mortality rates after pancreatojejunostomy and pancreatogastrostomy were similar but were less (0.5% vs. 1%; P = .014) when an externally draining, trans-anastomotic stent was placed intraoperatively. The incidence of the different Grades of POPF Grade was quite variable, but Grade C POPFs were associated with a PO mortality rate of 25.7% (range 0–100%).Conclusions:The POPF-related mortality rate has remained at approximately 1% over the past 25 years. Only externally draining, trans-anastomotic stents decreased the POPF-related mortality rate. However, adequately designed venting drains were never tested in randomized controlled trials (RCTs).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pancreatoduodenectomy (PD) and postoperative pancreatic fistula (POPF)

Pedrazzoli¹

2017

Medicine

162

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“…This includes the use of trypsin inhibitors, such as ulinastatin, which have been shown to decrease rates of both POP and POPF in two moderately sized RCTs. 129 , 130 Moreover, a recent RCT evaluating intravenous hydrocortisone in 155 patients undergoing PD demonstrated a significant reduction in overall postoperative complications and a nonsignificant trend toward reduction in POPF. 131…”

Section: Emerging Conceptsmentioning

confidence: 99%

Postoperative pancreatic fistula: a review of traditional and emerging concepts

Nahm¹,

Connor²,

Samra³

et al. 2018

CEG

152

125

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Postoperative pancreatic fistula (POPF) remains the major cause of morbidity after pancreatic resection, affecting up to 41% of cases. With the recent development of a consensus definition of POPF, there has been a large number of reports examining various risk factors, prediction models, and mitigation strategies for this costly complication. Despite these strategies, the rates of POPF have not significantly diminished. Here, we review the literature and evidence regarding both traditional and emerging concepts in POPF prediction, prevention, and management. In particular, we review the evidence for the association between postoperative pancreatitis and POPF, and present a novel proposed mechanism for the development of POPF.

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“…UTI is a member of inter-a-inhibitor (IaI) family, which is produced by hepatocytes (Linder and Russell, 2014). It was originally used to treat acute pancreatitis or hyperthermia (Itaba et al, 2013; Zhang et al, 2016). Subsequently, more studies revealed its use in anti-inflammation and the protection of liver function as well as in cardiopulmonary bypass and lung disease treatment (Song et al, 2011; Li et al, 2016).…”

Section: Discussionmentioning

confidence: 99%

Improvement of Sepsis Prognosis by Ulinastatin: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

et al. 2019

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Background: Ulinastatin has been prescribed to treat sepsis. However, there is doubt regarding the extent of any improvement in outcomes to guide future decision making.Objectives: To evaluate the effects of ulinastatin on mortality and related outcomes in sepsis patients.Methods: Thirteen randomized controlled trials and two prospective studies published before September 1, 2018, that included 1358 patients with sepsis, severe sepsis, or septic shock were evaluated. The electronic databases searched in this study were PubMed, Medline, Embase, and China National Knowledge Infrastructure (CNKI) for Chinese Technical Periodicals.Results: Ulinastatin significantly decreased the all-cause mortality {odds ratio (OR) = 0.48, 95% confidence interval (CI) [0.35–0.66], p < 0.00001, I2 = 13%}, Acute Physiology, Age, Chronic Health Evaluation II (APACHE II) score {mean difference (MD) = −2.40, 95% CI [−4.37, −0.44], p = 0.02, I2 = 66%}, and reduced the incidence of multiple organ dysfunction syndrome (MODS) (OR = 0.3, 95% CI [0.18, 0.49], p < 0.00001, I2 = 0%). Ulinastatin also decreased the serum levels of IL-6 (MD = −88.5, 95% CI [−123.97, −53.04], p < 0.00001), TNF-α (MD = −56.22, 95% CI [−72.11, −40.33], p < 0.00001), and increased the serum levels of IL-10 (MD = 37.73, 95% CI [16.92, 58.54], p = 0.0004). Ulinastatin administration did not lead to any difference in the occurrence of adverse events.Conclusions: Ulinastatin improved all-cause mortality and other related outcomes in patients with sepsis or septic shock. The results of this meta-analysis suggest that ulinastatin may be an effective treatment for sepsis and septic shock.

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Preventive effects of ulinastatin on complications related to pancreaticoduodenectomy

Cited by 16 publications

References 34 publications

Pancreatoduodenectomy (PD) and postoperative pancreatic fistula (POPF)

Pancreatoduodenectomy (PD) and postoperative pancreatic fistula (POPF)

Postoperative pancreatic fistula: a review of traditional and emerging concepts

Improvement of Sepsis Prognosis by Ulinastatin: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

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