The Use of Prophylactic Somatostatin Therapy Following Pancreaticoduodenectomy: A Meta‐analysis of Randomised Controlled Trials

Adiamah, Alfred; Arif, Zainab; Berti, Francesco; Singh, Sheila K.; Laskar, Nabila; Gomez, Dhanny

doi:10.1007/s00268-019-04956-6

Cited by 36 publications

(30 citation statements)

References 61 publications

(162 reference statements)

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“…To date, many studies have explored somatostatin or its analogs as prophylaxis against POPF in patients underwent PD 8 . However, there has been no unified consensus regarding their routine prophylactic use for POPF 9 , 10 . Therefore, the effect of somatostatin on POPF remains to be further studied.…”

Section: Introductionmentioning

confidence: 99%

Gut microbiota patterns associated with somatostatin in patients undergoing pancreaticoduodenectomy: a prospective study

Zhang

WeiGuang

et al. 2020

Cell Death Discov.

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Postoperative pancreatic fistula (POPF) is a common and dreaded complication after pancreaticoduodenectomy (PD). The gut microbiota has been considered as an crucial mediator of postoperative complications, however, the precise roles of gut microbiota in POPF are unclear. A prospective study was developed to explore the effects of somatostatin on gut microbiota and we aim to identify the microbial alterations in the process of POPF. A total of 45 patients were randomly divided into PD group or additional somatostatin therapy group. The fecal sample of each patient was collected preoperatively and postoperatively and the gut microbiota was analyzed by 16S rRNA sequencing. Our study found that somatostatin therapy was independent risk factor for the occurrence of POPF, and it reduced the microbial diversity and richness in patients. At genus level, somatostatin therapy led to a decreased abundance in Bifidobacterium, Subdoligranulum and Dubosiella, whereas the abundance of Akkermansia, Enterococcus and Enterobacter were increased. The abundance levels of certain bacteria in the gut microbiota have significantly shifted in patients with POPF. The LEfSe analysis revealed that Ruminococcaceae could be used as microbial markers for distinguishing patients with high risk of POPF. Furthermore, Verrucomicrobia and Akkermansia could be used as preoperative biomarkers for identifying patients without POPF. Our prospective study highlights the specific communities related with somatostatin therapy and discovers POPF-associated microbial marker, which suggests that gut microbiota may become a diagnostic biomarker and potential therapeutic target for POPF.

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Section: Introductionmentioning

confidence: 99%

Gut microbiota patterns associated with somatostatin in patients undergoing pancreaticoduodenectomy: a prospective study

Zhang

WeiGuang

et al. 2020

Cell Death Discov.

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“…[13] However, an updated meta-analysis shows that prophylactic somatostatin analogs do not improve the postoperative outcomes or reduce the incidence of pancreatic fistula following pancreaticoduodenectomy. [14] Patients presenting with a history of gut neuroendocrine tumors or carcinoid syndrome can experience life-threatening carcinoid crises during anesthesia or surgery, and continuous infusions of high-dose octreotide can minimize intraoperative carcinoid crises. [15] However, another study indicates that octreotide infusions do not prevent intraoperative carcinoid crises in carcinoid patients.…”

Section: Discussionmentioning

confidence: 99%

Prophylactic octreotide does not reduce the incidence of postoperative chylothorax following lobectomy

Zhang

et al. 2019

Medicine

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Chylothorax after lobectomy is common, lacking reliable preventive measures. Octreotide is widely used for treatment of chyle leakage, but its role in preventing chylothorax has not been estimated. The aim of this study was to evaluate whether prophylactic octreotide could reduce the incidence of postoperative chylothorax. Patients who underwent lobectomy for lung cancer from January 2016 to September 2018 were retrospectively reviewed. The cases in prophylactic group received octreotide 1 day before the surgery until removal of chest tubes, while those in the control group did not use it unless the diagnosis of chylothorax. A total of 379 patients were enrolled, with 190 patients in control and 189 cases in prophylactic group. Octreotide was well tolerated in patients who received this agent. No 30-day mortality was indicated. Seven cases in control (3.7%, 7/190) and 3 cases in prophylactic group (1.6%, 3/189) with chylothorax were observed ( P = .337). The patients in prophylactic group showed shorter duration of chest drainage ([3.6 ± 1.6] days vs [4.1 ± 2.0] days, P = .006) and reduced drainage volume ([441.8 ± 271.1] mL vs [638.7 ± 463.3] mL, P < .001). In addition, they showed similar stations and numbers of dissected lymph nodes, surgery-related complications, and postoperative hospital stay. Besides, 11 (5.8%, 11/190) patients in control and 6 (3.2%, 6/189) cases in the prophylactic group were readmitted for pleural effusion needing reinsertion of chest tubes ( P = .321). Moreover, multivariable logistic analysis showed that induction therapy (odds ratio [OR] =12.03; 95% confidence interval [CI] 3.15–46.03, P < .001) was a risk factor, while high-volume experience of the surgeon (OR = 0.23; 95% CI 0.06–0.97, P = .045) was a preventive factor of surgery-related chylothorax. Additionally, prophylactic octreotide (OR = 0.18; 95% CI 0.11–0.28, P < .001) and perioperative low-fat diet (OR = 0.46; 95% CI 0.29–0.73, P = .001) were negatively associated with the drainage volume of pleural effusion. Furthermore, high-volume experience of the surgeon (OR = 6.03; 95% CI 1.30–27.85, P = .021) and induction therapy (OR = 8.87; 95% CI 2.97–26.48, P < .001) were risk factors of unplanned readmission. Prophylactic octreotide does not reduce the incidence of postoperative chylothorax or unplanned readmission following anatomic lobectomy. The routine application of octreotide should not be recommended. High-quality trials are required to validate these findings.

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“…6 A recent meta-analysis, including this randomized controlled trial (RCT) and 11 others utilizing octreotide and other somatostatin analogs, found no reduction in POPF incidence following PD. 9 Given these conflicting results, it is not surprising that the administration of octreotide after pancreatectomy likely remains surgeon specific.…”

Section: Introductionmentioning

confidence: 99%

Meta-Analysis on the Effect of Pasireotide for Prevention of Postoperative Pancreatic Fistula

Dalton

Johns

Rhodes

et al. 2020

The American Surgeon

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Background A randomized controlled trial of routine administration of pasireotide demonstrated decreased incidence of clinically significant postoperative pancreatic fistula (POPF). Recent studies have not replicated these results. A meta-analysis was performed to evaluate its efficacy in this setting. Methods Prospective trials utilizing pasireotide prophylactically after pancreatectomy were reviewed. The primary outcome was clinically significant POPF. Secondary outcomes included length of stay (LOS), readmission rates, and mortality. Study heterogeneity was assessed. Results Five studies totaling 1571 patients were identified. There was no difference in age, sex, or cancer rates. Pasireotide patients had smaller pancreatic ducts ( P < .001) and softer glands ( P = .04). For all pancreatectomies, there was no difference in POPF rates (odds ratio [OR] 0.84; 95% CI 0.60-1.16, P = .29). Patients undergoing distal pancreatectomy (OR 0.70; 95% CI 0.30-1.63, P = .41) had similar rates of POPF versus pancreaticoduodenectomy (PD) patients who experienced a lower incidence of POPF (OR 0.60; 95% CI 0.42-0.86, P = .006). Mortality rates and LOS were similar. Readmission rates were decreased with pasireotide (OR 0.61; 95% CI 0.44-0.85). Conclusions Routine administration of pasireotide did not decrease POPF rates for all pancreatectomies, but was associated with lower rates for PD, and decreased readmission rates. Further prospective, randomized studies are warranted.

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The Use of Prophylactic Somatostatin Therapy Following Pancreaticoduodenectomy: A Meta‐analysis of Randomised Controlled Trials

Cited by 36 publications

References 61 publications

Gut microbiota patterns associated with somatostatin in patients undergoing pancreaticoduodenectomy: a prospective study

Gut microbiota patterns associated with somatostatin in patients undergoing pancreaticoduodenectomy: a prospective study

Prophylactic octreotide does not reduce the incidence of postoperative chylothorax following lobectomy

Meta-Analysis on the Effect of Pasireotide for Prevention of Postoperative Pancreatic Fistula

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