The Potent Somatostatin Analogue Vapreotide Does Not Decrease Pancreas-Specific Complications After Elective Pancreatectomy: A Prospective, Multicenter, Double-Blinded, Randomized, Placebo-Controlled Trial

Sarr, M. G.

doi:10.1016/s1072-7515(03)00104-2

Cited by 167 publications

(120 citation statements)

References 19 publications

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“…However, this technique is seldom used and not is recommended on a routine basis for the diagnosis of pancreatic fistula [5,14,16,27]. We did not perform sinography-fistulography to confirm the diagnosis of pancreatic fistula because we believe, as do other authors [28], that the best way to diagnose pancreatic fistula is to closely monitor the output of the drain in the pancreatic bed.…”

Section: Ct Of Pancreatic Fistulamentioning

confidence: 98%

Utility of CT in the Diagnosis of Pancreatic Fistula After Pancreaticoduodenectomy in Patients with Soft Pancreas

Bruno

Brancatelli

Sauvanet

et al. 2009

American Journal of Roentgenology

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W175as "drain output of any measurable volume of fluid on or after postoperative day 3 with an amylase content greater than three times the serum amylase activity" [11].The overall rate of pancreatic fistula after pancreaticoduodenectomy ranges from 17% in patients in whom the pancreatic remnant has a hard consistency [12] and exocrine pancreatic function and pancreatic juice output are impaired [13] to 25% in cases in which the pancreas is soft [1], that is, the parenchyma is normal [13]. Soft pancreatic texture [1,3,13] and small pancreatic duct size [3] are the most important preoperative risk factors for the development of pancreatic fistula.The diagnosis of pancreatic fistula usually is made an average of 7 days after pancreaticoduodenectomy [5,14,15]. Pancreatic fistula diagnosed with repeated assays of pancreatic enzymes in peripancreatic fluid drainage [11,14,16] © American Roentgen Ray Society P ancreaticoduodenectomy is safe in the management of various malignant and benign diseases of the pancreatic head and periampullary region. Although the mortality rate has decreased to approximately 1-2% at high-volume centers, the morbidity rate ranges from 30% to 50% [1][2][3][4]. The two most frequent complications of pancreaticoduodenectomy are delayed gastric emptying and pancreatic fistula. G a s t r oi nt e s t i n a l I m ag i ng • O r ig i n a l R e s e a rc hPancreatic fistula after pancreaticoduodenectomy is a serious complication resulting in prolonged hospital stay, increased costs, readmission, and a mortality rate of 3-9% [5,6]. Efforts to reduce the incidence of pancreatic fistula have included definition of risk factors [1,7], improvement of surgical technique [8,9], and perioperative administration of somatostatin and its analogues [1,10]. The International Study Group on Pancreatic Fistula has defined pancreatic fistula OBJECTIVE. The purpose of this study was to evaluate the sensitivity and specificity of routine performance of CT on postoperative day 7 in patients at high risk of pancreatic fistula after pancreaticoduodenectomy.MATERIALS AND METHODS. Two radiologists analyzed images from CT examinations of 50 patients with soft pancreas 7 days after pancreaticoduodenectomy. Pancreatic fistula was defined at CT as a fluid collection close to the pancreaticogastric or pancreaticojejunal anastomosis. Clinicobiologic criteria for the diagnosis of pancreatic fistula were drain output of any measurable volume of fluid on or after postoperative day 3 that had an amylase content more than three times the serum amylase activity. The final diagnosis of pancreatic fistula was rendered on the basis of clinicobiologic data at hospital discharge or at first readmission.RESULTS. At hospital discharge or at first readmission, 27 of 50 patients (54%) had a pancreatic fistula. On postoperative day 7, 30 patients (60%) had a total of 51 fluid collections, and CT showed a fluid collection close to the pancreaticogastric or pancreaticojejunal anastomosis in 21 of 51 cases. CT had a sensitivity of 63% (17/27 pat...

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Section: Ct Of Pancreatic Fistulamentioning

confidence: 98%

Utility of CT in the Diagnosis of Pancreatic Fistula After Pancreaticoduodenectomy in Patients with Soft Pancreas

Bruno

Brancatelli

Sauvanet

et al. 2009

American Journal of Roentgenology

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“…The rate of clinically significant pancreatic leak was 12% in the octreotide group and 6% in the control group (p = 0.23) and the perioperative morbidity was 30 and 25%, respectively. The latest published trial from the USA, is a multicentre, double-blind, placebo-controlled trial of vapreotide in 275 patients, of whom 135 received vapreotide and 140 patients received placebo [76]. The procedures performed were pancreato-duodenectomy in 215 patients, left pancreatectomy in 52 and central pancreatectomy in the other 8 patients.…”

Section: Complications Of Pancreatic Fistulamentioning

confidence: 99%

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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“…While this case is rare, this suggests that patients diagnosed with POPF Grade A or no POPF could actually have POPF Grade B and we should therefore also predict POPF grade A. Several definitions of POPF after PD were proposed using drain output and/or amylase levels of drain fluid [20][21][22][23]; the ISGPF guidelines have become the gold standard for POPF diagnosis since 2005. However, as our previously mentioned case showed, it is essential to carefully observe the postoperative clinical course of patients undergoing PD even if they do not fulfill the ISGPF guidelines.…”

Section: Discussionmentioning

confidence: 99%

A Rapid Predictive System for Pancreatic Fistula after Pancreaticoduodenectomy: A Report from a Low-Volume Center

Takeshima¹,

Kubochi²

2017

J Univer Surg

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The Potent Somatostatin Analogue Vapreotide Does Not Decrease Pancreas-Specific Complications After Elective Pancreatectomy: A Prospective, Multicenter, Double-Blinded, Randomized, Placebo-Controlled Trial

Cited by 167 publications

References 19 publications

Utility of CT in the Diagnosis of Pancreatic Fistula After Pancreaticoduodenectomy in Patients with Soft Pancreas

Utility of CT in the Diagnosis of Pancreatic Fistula After Pancreaticoduodenectomy in Patients with Soft Pancreas

Surgical Treatment of Pancreatic Fistula

A Rapid Predictive System for Pancreatic Fistula after Pancreaticoduodenectomy: A Report from a Low-Volume Center

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