Efficacy of octreotide in the prevention of pancreatic fistula after elective pancreatic resections: A prospective, controlled, randomized clinical trial

Montorsi, Marco; Zago, Mauro; Mosca, Franco; Capussotti, Lorenzo; Zotti, E; Ribotta, G; Fegiz, G; Fissi, S.; Roviaro, Giancarlo; Peracchia, A.; Pivi, Marcella; Perego, Rita; Pezzuoli, G

doi:10.1016/s0039-6060(05)80225-9

Cited by 281 publications

(174 citation statements)

References 12 publications

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“…[39][40][41][42] In all studies, fistula rate decreased after treatment with octreotide, although the incidence of evidenced pancreatic anastomotic leakage was not affected, [39][40][41][42] as our study documents. Transection of the pancreas with a linear stapler to enable easier hemostasis of the pancreatic remnant for anastomosis 43,44 did not decrease the incidence of leakage in this series.…”

supporting

confidence: 64%

Incidence, Risk Factors, and Treatment of Pancreatic Leakage After Pancreaticoduodenectomy: Drainage versus Resection of the Pancreatic Remnant

Henegouwen

Wit

Gulik³

et al. 1997

Journal of the American College of Surgeons

253

195

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Disclaimer/Complaints regulationsIf you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the material inaccessible and/or remove it from the website. Please Ask the Library: http://uba.uva.nl/en/contact, or a letter to: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam, The Netherlands. You will be contacted as soon as possible. One group comprised patients undergoing percutaneous or surgical drainage procedures; the other had patients undergoing resection of the pancreatic remnant. RESULTS:Twenty-nine patients (11%) had clinical manifestations of pancreatic leakage, and the mortality in these patients was 28% (overall mortality: 3.7%). Leakage occurred after a median of 5 days (range 1-20). Age, preoperative bilirubin level, and albumin counts were not risk factors for pancreatic leakage. Small pancreatic duct size (Ͻ2mm) (pϽ0.01) and ampullary carcinoma as histopathologic diagnosis (pϽ0.05) were risk factors. The median number of relaparotomies was two (range 0-4) in the drainage group (nϭ21), versus 1.5 (range 1-5) in patients who underwent resection (nϭ8). The median hospital stay was 74 days (range 36-219), versus 55 days (range 22-107) for the drainage and resection groups, respectively (pϽ0.05). Mortality was lower in patients who underwent resection, 38 versus 0% (pϽ0.05). CONCLUSIONS: Leakage of the pancreatic anastomosis is a severe complication after pancreaticoduodenectomy and carries a high mortality rate (28%). Completion pancreatectomy could be performed without additional mortality. In patients with severe and persistent leakage of the anastomosis, early completion pancreatectomy is the treatment of choice. (J Am

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supporting

confidence: 64%

Incidence, Risk Factors, and Treatment of Pancreatic Leakage After Pancreaticoduodenectomy: Drainage versus Resection of the Pancreatic Remnant

Henegouwen

Wit

Gulik³

et al. 1997

Journal of the American College of Surgeons

253

195

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“…Prophylactic use of octreotide is expected theoretically to reduce the incidence rate of the pancreatic fistula through decreasing pancreatic juice secretion. However, randomized trials from Europe and United states showed opposite results [23][24][25][26] . In our study, there was no significant difference in the incidence rate of pancreatic fistula between postoperative prophylactic octreotide usage group and no usage group (P = 0.347).…”

Section: Discussionmentioning

confidence: 97%

Pancreatic fistula after pancreaticoduodenectomy: A comparison between the two pancreaticojejunostomy methods for approximating the pancreatic parenchyma to the jejunal seromuscular layer: Interrupted vs continuous stitches

Lee

Yang

Jang³

et al. 2007

WJG

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AIM:The purpose of this study is to find a better operative technique by comparing interrupted stitches with continuous stitches for the outer layer of the pancreaticojejunostomy, i.e., the stitches between the stump parenchyma of the pancreas and the jejunal seromuscular layer, and other risk factors for the incidence of pancreatic leakage. METHODS:During the period January 1997 to October 2004, 133 patients have undergone the end-to-side and duct-to-mucosa pancreaticojejunostomy reconstruction after pancreaticoduodenectomy with interrupted suture for outer layer of the pancreaticojejunostomy and 170 patients with a continuous suture at our institution by one surgeon. RESULTS:There were no significant differences between the two groups in the diagnosis, texture of the pancreas, use of octreotide and pathologic stage. Pancreatic fistula occurred in 14 patients (11%) among the interrupted suture cases and in 10 (6%) among the continuous suture cases (P = 0.102). Major pancreatic leakage developed in three interrupted suture patients (2%) and zero continuous suture patients (P = 0.026). In multivariate analysis, soft pancreatic consistency (odds ratio, 5.5; 95% confidence interval 2.3-13.1) and common bile duct cancer (odds ratio, 3.7; 95% CI 1.6-8.5) were predictive of pancreatic leakage. CONCLUSION:Pancreatic texture and pathology are the most important factors in determining the fate of pancreaticojejunal anastomosis and our continuous suture method was performed with significantly decreased occurrence of major pancreatic fistula. In conclusion, the continuous suture method is more feasible and safer in performing duct-to-mucosa pancreaticojejunostomy.

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“…Table 6 shows a comparison of multiple postoperative parameters for the 17 patients with pancreatic fistula to the 128 patients without pancreatic fistula. Many parameters are significantly different in a comparison of these 47 19 0.01 41 14 0.01 24 5 0 Pancreaticogastrostomy has gained favor in recent years as a potential means of reducing the incidence of pancreatic fistula after pancreaticoduodenectomy.2629 Proponents of PG have noted several potential advantages. First, the PG anastomosis can be easier to perform, because the posterior wall of the stomach lies immediately anterior to the mobilized pancreatic remnant and is always wider than the transected pancreatic neck.…”

Section: Study End Pointsmentioning

confidence: 99%

A Prospective Randomized Trial of Pancreaticogastrostomy Versus Pancreaticojejunostomy After Pancreaticoduodenectomy

et al. 1995

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ObjectiveThe authors hypothesized that pancreaticogastrostomy is safer than pancreaticojejunostomy afte pancreaticoduodenectomy and less likely to be associated with a postoperative pancreatic fistula Summary Background DataPancreatic fistula is a leading cause of morbidity and mortality after pancreaticoduodenectomy, occurring in 10% to 20% of patients. Nonrandomized reports have suggested that pancreaticogastrostomy is less likely than pancreaticojejunostomy to be associated with postoperative complications. MethodsBetween May 1993 and January 1995, the findings for 145 patients were analyzed in this prospective trial at The Johns Hopkins Hospital. After giving their appropriate preoperative informed consent, patients were randomly assigned to pancreaticogastrostomy or pancreaticojejunostomy after completion of the pancreaticoduodenal resection. All pancreatic anastomoses were performed in two layers without pancreatic duct stents and with closed suction drainage. Pancreatic fistula was defined as drainage of greater than 50 mL of amylase-rid fluid on or after postoperative day 10. ResultsThe pancreaticogastrostomy (n = 73) and pancreaticojejunostomy (n = 72) groups were comparable with regard to multiple parameters, including demographics, medical history, preoperative laboratory values, and intraoperative factors, such as operative time, blood transfusions, pancreatic texture, length of pancreatic remnant mobilized, and pancreatic duct diameter. The overall incidence of pancreatic fistula after pancreaticoduodenectomy was 11.7% (17/145). The incidence of pancreatic fistula was similar for the pancreaticogastrostomy (12.3%) and pancreaticojejunostomy (1 1.1 %) groups. Pancreatic fistula was associated with a significant prolongation of postoperative hospital stay (36 ± 5 vs. 15 ± 1 days) (p < 0.001). Factors significantly increasing the risk of pancreatic fistula by univariate logistic regression analysis included ampullary or duodenal disease, soft pancreatic texture, longer operative time, greater intraoperative red blood cell transfusions, and lower surgical volume (p < 0.05). A multivariate 580

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Efficacy of octreotide in the prevention of pancreatic fistula after elective pancreatic resections: A prospective, controlled, randomized clinical trial

Cited by 281 publications

References 12 publications

Incidence, Risk Factors, and Treatment of Pancreatic Leakage After Pancreaticoduodenectomy: Drainage versus Resection of the Pancreatic Remnant

Incidence, Risk Factors, and Treatment of Pancreatic Leakage After Pancreaticoduodenectomy: Drainage versus Resection of the Pancreatic Remnant

Pancreatic fistula after pancreaticoduodenectomy: A comparison between the two pancreaticojejunostomy methods for approximating the pancreatic parenchyma to the jejunal seromuscular layer: Interrupted vs continuous stitches

A Prospective Randomized Trial of Pancreaticogastrostomy Versus Pancreaticojejunostomy After Pancreaticoduodenectomy

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