The effect of somatostatin and its analogs in the prevention of pancreatic fistula after elective pancreatic surgery

Čečka, Filip; Jon, Bohumil; Subrt, Z; Ferko, Alexander

doi:10.1007/s10353-011-0612-z

Cited by 6 publications

(4 citation statements)

References 62 publications

(161 reference statements)

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“…Our literature search identified 13 RCTs and 12 systematic reviews on the effectiveness of somatostatin analogues to reduce pancreatic fistula complications after pancreatic surgery [224–247]. The latest Cochrane review on the effectiveness of somatostatin analogues was published in 2013 [247].…”

Section: Resultsmentioning

confidence: 99%

Guidelines for Perioperative Care for Pancreatoduodenectomy: Enhanced Recovery After Surgery (ERAS) Recommendations 2019

et al. 2020

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Background Enhanced recovery after surgery (ERAS) pathways are now implemented worldwide with strong evidence that adhesion to such protocol reduces medical complications, costs and hospital stay. This concept has been applied for pancreatic surgery since the first published guidelines in 2012. This study presents the updated ERAS recommendations for pancreatoduodenectomy (PD) based on the best available evidence and on expert consensus. Methods A systematic literature search was conducted in three databases (Embase, Medline Ovid and Cochrane Library Wiley) for the 27 developed ERAS items. Quality of randomized trials was assessed using the Consolidated Standards of Reporting Trials statement checklist. The level of evidence for each item was determined using the Grading of Recommendations Assessment Development and Evaluation system. The Delphi method was used to validate the final recommendations. Results A total of 314 articles were included in the systematic review. Consensus among experts was reached after three rounds. A well-implemented ERAS protocol with good compliance is associated with a reduction in medical complications and length of hospital stay. The highest level of evidence was available for five items: avoiding hypothermia, use of wound catheters as an alternative to epidural analgesia, antimicrobial and thromboprophylaxis protocols and preoperative nutritional interventions for patients with severe weight loss ([ 15%). Conclusions The current updated ERAS recommendations for PD are based on the best available evidence and processed by the Delphi method. Prospective studies of high quality are encouraged to confirm the benefit of current updated recommendations.

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Section: Resultsmentioning

confidence: 99%

Guidelines for Perioperative Care for Pancreatoduodenectomy: Enhanced Recovery After Surgery (ERAS) Recommendations 2019

et al. 2020

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“…Besides the uses of somatostatin or its analogs in high-risk patients ( 25 ), the occurrence of POPF and FCs can decrease sharply. In the present, the drainage tube is no less that important.…”

Section: Discussionmentioning

confidence: 99%

A new enhanced recovery after surgery pathway for left-sided pancreatic cancer patients after distal pancreatectomy

Wang¹,

Li²,

Weng³

et al. 2019

Transl. Cancer Res.

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Background: Pancreatic surgeries are one of the most complex surgical procedures in general surgery that require highly experienced surgical technics and intensive postoperative care. Meanwhile the application of enhanced recovery after surgery (ERAS) program in pancreatic surgery is limited. The aim of this study was to attempt a new ERAS pathway specifically for patients after distal pancreatectomy (DP). Methods:Between May 2016 and November 2016, 29 patients undergoing DP in Shanghai Ruijin Hospital pancreatic disease center received the ERAS pathway. Meanwhile 19 patients were implemented traditional care. Complications, readmissions, mortality, length of stay (LOS) and drainage-tube-off day were compared and evaluated in the two groups.Results: Median length of stay was significantly reduced (18.37±2.55 days in ERAS group; 27.42±7.60 days in the control group) and drainage-tube-off days (5.89±2.41 versus 26.68±7.35 days). And no patient discharged with a drainage tube in ERAS group compared while 7 patients (36.8%) discharged with drainage tube in the conventional group. Postoperative pancreatic fistula (POPF) rate was decreased in ERAS group but not significantly. Readmission rates, as well as mortality, did not change over time. 9 patients were found postoperative abdominal fluid collections in ERAS group, and only 2 patients were confirmed real pancreatic fistula.Conclusions: Implementing the new ERAS program for DP may contribute to a decrease of LOS and drainage-tube-off days with a promising outcome. Therefore, an ERAS pathway specifically for DP should be established.

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“…Several methods have been studied in the past with the goal of lowering the pancreatic fistula rate. They include pharmacological prophylaxis with octreotide [ 7 ] and various technical modifications of pancreatic remnant management after pancreaticoduodenectomy [ 8 , 9 ] and after distal pancreatectomy [ 10 ]. However, the use of octreotide remains controversial, and none of the studied techniques proved to be superior.…”

Section: Introductionmentioning

confidence: 99%

DRAPA trial – closed-suction drains versus closed gravity drains in pancreatic surgery: study protocol for a randomized controlled trial

Čečka

Loveček

Jon

et al. 2015

Trials

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BackgroundThe morbidity of pancreatic resection remains high, with pancreatic fistula being the most common cause. The important question is whether any postoperative treatment adjustment may prevent the development of clinically significant postoperative pancreatic fistulae. Recent studies have shown that intraabdominal drains and manipulation using them are of great importance. Although authors of a few retrospective reports have described good results of pancreatic resection without the use of intraabdominal drains, a recent prospective randomized trial showed that routine elimination of drains in pancreaticoduodenectomy is associated with poor outcome. An important issue arises as to which type of drain is most suitable for pancreatic resection. Two types of surgical drains exist: open drains and closed drains. Open drains are considered obsolete nowadays because of frequent retrograde infection. Closed drains include two types: passive gravity drains and closed-suction drains. Closed-suction drains are more effective, as they remove fluid from the abdominal cavity under light pressure. However, some surgeons believe that closed-suction drains represent a potential hazard to patients and that negative pressure might increase the risk of pancreatic fistulae. Nobody has yet specifically dealt with the question of which kind of drainage is most appropriate in pancreatic surgery.Methods/DesignThe aim of the DRAins in PAncreatic surgery (DRAPA) trial is to compare the closed-suction drain versus the closed passive gravity drain in pancreatic resection. DRAPA is a dual-centre, prospective, randomized controlled trial. The primary endpoint is the rate of postoperative pancreatic fistula; the secondary endpoint is postoperative morbidity with follow-up of 3 months.DiscussionNo study to date has compared different types of drains in pancreatic surgery. This study is designed to answer the question whether any particular type of drain might lower the rate of postoperative pancreatic fistula or other complications.Trial registrationClinicalTrials.gov Identifier: NCT01988519. Registered 13 November 2013.

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The effect of somatostatin and its analogs in the prevention of pancreatic fistula after elective pancreatic surgery

Cited by 6 publications

References 62 publications

Guidelines for Perioperative Care for Pancreatoduodenectomy: Enhanced Recovery After Surgery (ERAS) Recommendations 2019

Guidelines for Perioperative Care for Pancreatoduodenectomy: Enhanced Recovery After Surgery (ERAS) Recommendations 2019

A new enhanced recovery after surgery pathway for left-sided pancreatic cancer patients after distal pancreatectomy

DRAPA trial – closed-suction drains versus closed gravity drains in pancreatic surgery: study protocol for a randomized controlled trial

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