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

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Abstract

Background

Prophylactic administration of somatostatin analogues (SA) to reduce the incidence of post-operative pancreatic fistula (POPF) remains contentious. This meta-analysis evaluated its impact on outcomes following pancreaticoduodenectomy (PD).

Methods

The EMBASE, MEDLINE and Cochrane databases were searched for randomised controlled trials (RCTs) investigating prophylactic SA following PD. Comparative effects were summarised as odds ratio and weighted mean difference based on an intention to treat. Quantitative pooling of the effect sizes was derived using the random-effects model.

Main results

Twelve RCTs were included involving 1615 patients [SA-treated group (n = 820) and control group (n = 795)]. The SA used included somatostatin-14, pasireotide, vapreotide and octreotide. Pooling of the data showed no significant benefit of its use for the primary outcome measure of all grades of POPF, odds ratio (OR) 0.73 [95% confidence interval (CI), 0.51–1.05, p = 0.09] and clinically relevant POPF, OR 0.48 [95% CI, 0.22–1.06, p = 0.07]. There were no benefits in the secondary outcome measures of delayed gastric emptying, OR 0.98 [95% CI, 0.57–1.69, p = 0.94]; infected abdominal collections, OR 0.80 [95% CI, 0.44–1.43, p = 0.80]; reoperation rates, OR 1.24 [95% CI, 0.73–2.13, p = 0.42]; duration of hospital stay, − 0.23 [95% CI − .59 to 1.13, p = 0.74]; and mortality, 1.78 [95% CI, 0.94–3.39, p = 0.08].

Conclusion

SA did not improve the post-operative outcomes following PD, including reducing the incidence of POPF. The routine administration of SA cannot be recommended following PD.

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Acknowledgements

The authors are grateful to Mr David J. Humes, Associate Professor of Surgical Epidemiology at the University of Nottingham, for his critical review of the manuscript and for the suggestions and amendments which we feel greatly enriched the final submission.

Funding

AA is funded by National Institute for Health Research Academic Clinical Fellowship.

Author information

Authors and Affiliations

  1. Department of Hepatobiliary and Pancreatic Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen’s Medical Centre, E Floor, West Block, Derby Road, Nottingham, NG7 2UH, UK

    A. Adiamah, Z. Arif, F. Berti, S. Singh, N. Laskar & D. Gomez

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  1. A. Adiamah
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  2. Z. Arif
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  3. F. Berti
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Contributions

AA conceived and designed the study, extracted and analysed the data, drafted the write-up and approved the final manuscript; ZA and FB extracted and analysed the data, drafted the write-up and approved the final manuscript; SS performed the analyses, drafted the write-up and approved the final manuscript; NL designed the study, drafted the manuscript and approved the final manuscript; DG conceived and designed the study, analysed the data, drafted the write-up and approved the final manuscript.

Corresponding author

Correspondence to D. Gomez.

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Appendix: Detailed search strategy

Appendix: Detailed search strategy

Database: Ovid MEDLINE(R) <1946 to May Week 1 2017>

Search strategy

1

Randomized Controlled Trials as Topic/(113072)

2

randomized controlled trial/(461944)

3

Random Allocation/(92524)

4

Double Blind Method/(146986)

5

Single Blind Method/(24505)

6

clinical trial/(520955)

7

clinical trial, phase i.pt. (18692)

8

clinical trial, phase ii.pt. (30051)

9

clinical trial, phase iii.pt. (13709)

10

clinical trial, phase iv.pt. (1465)

11

controlled clinical trial.pt. (94024)

12

randomized controlled trial.pt. (461944)

13

multicenter study.pt. (226952)

14

clinical trial.pt. (520955)

15

exp Clinical Trials as topic/(312693)

16

or/1–15 (1227275)

17

(clinical adj trial$).tw. (257855)

18

((singl$ or doubl$ or treb$ or tripl$) adj (blind$3 or mask$3)).tw. (144052)

19

PLACEBOS/(34925)

20

placebo$.tw. (178301)

21

randomly allocated.tw. (20018)

22

(allocated adj2 random$).tw. (22793)

23

or/17–22 (483928)

24

16 or 23 (1379829)

25

case report.tw. (216632)

26

letter/(929319)

27

historical article/(347336)

28

or/25–27 (1479758)

29

24 not 28 (1347097)

30

exp Pancreatic Fistula/or pancreas fistula.mp. (2648)

31

pancreas leak.mp. (2)

32

pancreas.mp. or *Pancreas/(121867)

33

anastomotic leak.mp. or *Anastomotic Leak/or *Anastomosis, Surgical/(8829)

34

32 and 33 (223)

35

exp Pancreatic Fistula/or pancreas fistula.mp. (2648)

36

30 or 31 or 34 or 35 (2841)

37

exp Pancreatectomy/or exp Pancreaticoduodenectomy/or pancreas surgery.mp. (17109)

38

exp Pancreatectomy/or pancreaticoduodenectomy.mp. or exp Pancreaticoduodenectomy/(17748)

39

pancreaticojejunostomy.mp. or exp Pancreaticojejunostomy/(1428)

40

exp Pancreaticoduodenectomy/or whipples procedure.mp. (6490)

41

exp Pancreatectomy/or pancreas resection.mp. (11572)

42

distal pancreatectomy.mp. (2359)

43

subtotal pancreatectomy.mp. (352)

44

partial pancreatectomy.mp. (517)

45

37 or 38 or 39 or 40 or 41 or 42 or 43 or 44 (19502)

46

36 and 45 (1363)

47

somatostatin.mp. or exp Somatostatin/(30589)

48

exp Octreotide/or exp Somatostatin/or somatostatin analogue.mp. (24335)

49

exp Octreotide/or exp Somatostatin/or somatostatin analogues.mp. (24535)

50

exp Octreotide/or octreotide.mp. (7164)

51

pasireotide.mp. (355)

52

lanreotide.mp. (880)

53

angiopeptin.mp. (102)

54

vapreotide.mp. (197)

55

47 or 48 or 49 or 50 or 51 or 52 or 53 or 54 (33483)

56

46 and 55 (103)

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Adiamah, A., Arif, Z., Berti, F. et al. The Use of  Prophylactic Somatostatin Therapy Following Pancreaticoduodenectomy: A Meta-analysis of Randomised Controlled Trials . World J Surg 43, 1788–1801 (2019). https://doi.org/10.1007/s00268-019-04956-6

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