Randomized controlled multicentre trial of somatostatin infusion after pancreaticoduodenectomy

Gouillat, C.; Chipponi, J; Baulieux, J.; Partensky, Christian; Saric, Jean; Gayet, Brice

doi:10.1046/j.0007-1323.2001.01906.x

Cited by 116 publications

(99 citation statements)

References 21 publications

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“…The postoperative complication rate in the octreotide group was 20 (16.4%) of 125 patients and 37 (29.6%) of 122 patients in the placebo group (p < 0.007). Similar results were reported from two multicentre studies from Italy [71, 72]with 218 and 252 patients, respectively, and from an institutional study with 75 patients from France [73](table 7). The latest published trial, also from France, randomised 230 patients who underwent pancreato-duodenectomy (n = 177) or distal pancreatectomy (n = 53) either to octreotide (n = 122) or placebo (n = 108) [74].…”

Section: Complications Of Pancreatic Fistulasupporting

confidence: 78%

Surgical Treatment of Pancreatic Fistula

Alexakis¹,

Sutton²,

Neoptolemos³

2004

Dig Surg

103

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Background: Pancreatic fistula remains a significant problem in pancreatic disease, trauma and surgery. Whilst improved diagnostic and treatment techniques, including endoscopic approaches, have resulted in considerably improved outcomes, surgical intervention remains an important aspect of treatment but has been relatively poorly documented. Aims: The aims were to review the recent world literature on the relative incidence of pancreatic fistula and the results of surgical treatment. Results: The pancreatic fistula rate following partial pancreato-duodenectomy was 421 (12.9%) in 3,268 patients in 13 large series; 80 (13.0%) in 671 patients after left pancreatectomy in 6 large series, and 28 (11.9%) in 243 patients after pancreatic trauma in 4 recent series. The success rate of surgical procedures for external pancreatic fistulae was 101 (90.2%) in 112 patients with an overall mortality of 7 (6.3%) reported in 9 series. For internal pancreatic fistulae the success rate of surgical treatment was 61 (92%) in 66 patients with an overall mortality of 6 (9%) reported in 7 series. Conclusions: The treatment of established pancreatic fistula remains challenging. Although surgical treatment is reserved for patients who have failed all other treatments, the success rate is 90–92% but with a mortality of 6–9%.

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Section: Complications Of Pancreatic Fistulasupporting

confidence: 78%

Surgical Treatment of Pancreatic Fistula

Alexakis¹,

Sutton²,

Neoptolemos³

2004

Dig Surg

103

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show abstract

“…However, the role of this treatment still remains unclear. Two randomized trials by Lowy et al [18] and Yeo et al [19] failed to identify a decrease in the pancreatic leakage in patients underwent pancreaticoduodenectomy, while Gouillat et al [20] demonstrated a decreased leak rate in a randomized trial of patients who underwent pancreaticoduodenectomy. Buchler et al [21] reported that the use of octreotide could prevent pancreatic fistula following pancreatic r e s e c t i o n .…”

Section: T a B L E 4 I N C I D E N C E O F P A N C R E A T I C F I S mentioning

confidence: 99%

Risk factors associated with pancreatic fistula after distal pancreatectomy, which technique of pancreatic stump closure is more beneficial?

Ridolfini

Alfieri²,

Gourgiotis³

et al. 2007

WJG

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AIM:To identify risk factors related to pancreatic fistula in patients undergoing distal pancreatectomy (DP) and to determine the effectiveness of using a stapled and a sutured closed of pancreatic stump. METHODS:Sixty-four patients underwent DP during a 10-year period. Information regarding diagnosis, operative details, and perioperative morbidity or mortality was collected. Eight risk factors were examined. RESULTS:Indications for DP included primary pancreatic disease (n = 38, 59%) and non-pancreatic malignancy (n = 26, 41%). Postoperative mortality and morbidity rates were 1.5% and 37% respectively; one patient died due to sepsis and two patients required a reoperation due to postoperative bleeding. Pancreatic fistula was developed in 14 patients (22%); 4 of fistulas were classified as Grade A, 9 as Grade B and only 1 as Grade C. Incidence of pancreatic fistula rate was significantly associated with four risk factors: pathology, use of prophylactic octreotide therapy, concomitant splenectomy, and texture of pancreatic parenchyma. The role that technique (either stapler or suture) of pancreatic stump closure plays in the development of pancreatic leak remains unclear. CONCLUSION:The pancreatic fistula rate after DP is 22%. This is reduced for patients with non-pancreatic malignancy, fibrotic pancreatic tissue, postoperative prophylactic octreotide therapy and concomitant splenectomy.

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“…These studies were not double-blinded or placebo-controlled [86, 87]and Yeo et al [87]had a high exclusion rate. Gouillat et al [89]showed that continuous somatostatin-14 infusion significantly reduced the pancreatic fistula rate and the total pancreatic stump-related complication rate also in a multicentre, double-blinded, placebo-controlled randomized trial.…”

Section: The Role Of Prophylactic Octreotide In the Prevention Of Commentioning

confidence: 99%

Complications of Pancreatic Cancer Resection

et al. 2002

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Pancreatic cancer is a common cause of cancer death in the developed world. Currently, resection is the only chance of long-term survival. The post-operative mortality in nonspecialist centres often exceeds 20% but is around 6% or less in specialist centres. The overall complication rate even in specialist centres is 18–54%. An analysis of eleven large series of pancreatic resections shows an incidence of common complications of 10.4% for fistula, 9.9% for delayed gastric emptying, 4.8% for bleeding, 4.8% for wound infection and 3.8% for intra-abdominal abscess. The median hospital stay is 13–18 days in different series. The re-operation rate varies from 4 to 9% with a mortality rate of 23 to 67%. Major complications are a significant factor in post-operative mortality, especially if they require re-operation. The use of octreotide or somatostatin to prevent complications is supported by several multicentre, double-blind, randomized controlled trials. The best way to improve outcome is to concentrate pancreatic cancer care in regional specialist centres.

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Randomized controlled multicentre trial of somatostatin infusion after pancreaticoduodenectomy

Abstract: Although the effect of S-14 on exocrine secretion remains difficult to demonstrate, it did reduce pancreatic juice leakage from the pancreatic remnant.

Cited by 116 publications

References 21 publications

Surgical Treatment of Pancreatic Fistula

Surgical Treatment of Pancreatic Fistula

Risk factors associated with pancreatic fistula after distal pancreatectomy, which technique of pancreatic stump closure is more beneficial?

Complications of Pancreatic Cancer Resection

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