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Intervention Review

Somatostatin analogues for pancreatic surgery

  1. Kurinchi Selvan Gurusamy1,*,
  2. Rahul Koti2,
  3. Giuseppe Fusai2,
  4. Brian R Davidson1

Editorial Group: Cochrane Upper Gastrointestinal and Pancreatic Diseases Group

Published Online: 17 FEB 2010

Assessed as up-to-date: 9 NOV 2009

DOI: 10.1002/14651858.CD008370

How to Cite

Gurusamy KS, Koti R, Fusai G, Davidson BR. Somatostatin analogues for pancreatic surgery. Cochrane Database of Systematic Reviews 2010, Issue 2. Art. No.: CD008370. DOI: 10.1002/14651858.CD008370.

Author Information

  1. 1

    Royal Free Campus, UCL Medical School, Department of Surgery, London, UK

  2. 2

    Royal Free Hospital and University College School of Medicine, University Department of Surgery, London, UK

*Kurinchi Selvan Gurusamy, Department of Surgery, Royal Free Campus, UCL Medical School, Royal Free Hospital,, Pond Street, London, NW3 2QG, UK. kurinchi2k@hotmail.com.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 17 FEB 2010

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary

Background

Pancreatic resections are associated with high morbidity (30% to 60%) and mortality (5%). Synthetic analogues of somatostatin are advocated by some surgeons to reduce complications following pancreatic surgery, however their use is controversial.

Objectives

To determine whether prophylactic somatostatin analogues should be used routinely in pancreatic surgery.

Search methods

We searched the Cochrane Upper Gastrointestinal and Pancreatic Diseases Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, issue 4), MEDLINE, EMBASE and Science Citation Index Expanded to November 2009.

Selection criteria

We included randomised controlled trials comparing prophylactic somatostatin or one of its analogues versus no drug or placebo during pancreatic surgery (irrespective of language or publication status).

Data collection and analysis

Two authors independently assessed trials for inclusion and independently extracted data. We analysed data with both the fixed-effect and the random-effects models using Review Manager (RevMan). We calculated the risk ratio (RR), mean difference (MD) or standardised mean difference (SMD) with 95% confidence intervals (CI) based on an intention-to-treat or available case analysis. When it was not possible to perform either of the above, we performed per protocol analysis.

Main results

We identified 17 trials (of high risk of bias) involving 2143 patients. The overall number of patients with postoperative complications was lower in the somatostatin analogue group (RR 0.71; 95% CI 0.62 to 0.82) but there was no difference in the perioperative mortality, re-operation rate or hospital stay between the groups. The incidence of pancreatic fistula was lower in the somatostatin analogue group (RR 0.64; 95% CI 0.53 to 0.78). The proportion of these fistulas that were clinically significant was not mentioned in most trials. On inclusion of trials that clearly distinguished clinically significant fistulas, there was no difference between the two groups (RR 0.69; 95% CI 0.34 to 1.41). Subgroup analysis revealed a shorter hospital stay in the somatostatin analogue group than the controls for patients with malignant aetiology (MD -7.57; 95% CI -11.29 to -3.84).

Authors' conclusions

Somatostatin analogues reduce perioperative complications but do not reduce perioperative mortality. In those undergoing pancreatic surgery for malignancy, they shorten hospital stay. Further adequately powered trials with low risk of bias are necessary. Based on the current available evidence, somatostatin and its analogues are recommended for routine use in patients undergoing pancreatic resection for malignancy. There is currently no evidence to support their routine use in pancreatic surgeries performed for other indications.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary

Somatostatin analogues for reducing complications following pancreatic surgery

Pancreatic resections are associated with high morbidity (30% to 60%) and mortality (5%). It is not clear whether routine, preventative use of synthetic analogues of somatostatin (a hormone which inhibits pancreatic secretions) could reduce complications following pancreatic surgery. We included 17 randomised clinical trials in this review. All trials had high risk of bias ('systematic error'). A total of 2143 patients were randomised either to somatostatin analogues or a control in the 17 trials. The overall number of patients with postoperative complications was lower by 29% in the somatostatin analogues group but there was no difference in postoperative mortality, re-operation rate or overall length of hospital stay between the groups. Pancreatic fistula is drainage of pancreatic juice secreted by the remaining pancreas to the exterior. This was lower in the intervention group by 36%. The proportion of these fistulas that resulted in change to the treatment given to the patients is not clear. When we included trials that clearly distinguished fistulas that required change to the treatment given to the patients, there was no difference between the two groups. In a subgroup analysis we found a shorter hospital stay (by seven days on an average) in the somatostatin analogue group than in controls, where patients were undergoing pancreatic surgery for cancer. In conclusion, somatostatin analogues reduce the incidence of pancreatic fistula and in those undergoing pancreatic surgery for cancer, they shorten hospital stay. Further trials with sufficient patient numbers and a low risk of bias are necessary. Based on the current available evidence, somatostatin and its analogues are recommended for routine use in patients undergoing pancreatic resection for cancer. There is currently no evidence to support their routine use in pancreatic surgeries performed for other reasons.