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World Journal of Surgery
Published in: World Journal of Surgery 7/2019

01-07-2019 | Pancreatic Surgery | Scientific Review

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

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

Published in: World Journal of Surgery | Issue 7/2019

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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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Metadata
Title
The Use of  Prophylactic Somatostatin Therapy Following Pancreaticoduodenectomy: A Meta-analysis of Randomised Controlled Trials 
Authors
A. Adiamah
Z. Arif
F. Berti
S. Singh
N. Laskar
D. Gomez
Publication date
01-07-2019
Publisher
Springer International Publishing
Published in
World Journal of Surgery / Issue 7/2019
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-019-04956-6

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