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Octreotide in the Prevention of Intra-abdominal Complications Following Elective Pancreatic Resection
A Prospective, Multicenter Randomized Controlled Trial
Bertrand Suc, MD;
Simon Msika, MD;
Massimo Piccinini, MD;
Gilles Fourtanier, MD;
Jean-Marie Hay, MD;
Yves Flamant, MD;
Abe Fingerhut, MD, FRCS;
Pierre-Louis Fagniez, MD;
Jacques Chipponi, MD; for the French Associations for Surgical Research
Arch Surg. 2004;139:288-294.
Hypothesis Prophylactic administration of octreotide acetate decreases the rate of postoperative intra-abdominal complications (IACs) after elective pancreatic resection.
Design Single-blind, controlled, randomized trial.
Setting Multicenter (N = 20) trial in France.
Patients Of 230 randomized patients undergoing pancreatoduodenectomy and pancreatic enteric anastomosis or distal pancreatectomy for either malignant or benign tumor or chronic pancreatitis, 122 were allotted intraoperatively to receive octreotide; 108 served as controls.
Results All 230 patients were analyzed. Both groups were comparable except that significantly more patients in the octreotide group had biological glue injected into the main pancreatic duct alone (P<.001) or reinforcing the pancreatic enteric anastomosis (68% [83/122] vs 39% [42/108]; P = .002). Fewer patients (P = .08) in the octreotide group sustained 1 or more IACs (22% vs 32%). In subgroup analysis, octreotide significantly reduced the rate of patients sustaining 1 or more IACs when the main pancreatic duct diameter was less than 3 mm (P<.02), when pancreatojejunostomy was performed (P<.02), or both (P<.02). No significant differences were found regarding IAC severity. Twenty-three patients (10%) died postoperatively, 16 (70% of deaths) of whom had 1 or more IACs. The only independent risk factor for IACs found on multivariate analysis was pancreatoduodenectomy compared with distal pancreatectomy (P<.01) (odds ratio, 3.54 [95% confidence interval, 1.44-8.65]).
Conclusions Our results suggest that octreotide is not necessary for all patients undergoing pancreatic resection; it could be useful when the main pancreatic duct is less than 3 mm in diameter and when pancreatoduodenectomy is completed by pancreatojejunostomy.
From the Gastrointestinal Surgery Units, Hôpital Rangueil, Toulouse (Drs Suc and Fourtanier), Hôpital Louis Mourier (Assistance Publique des Hôpitaux de Paris [AP-HP]), Colombes (Drs Msika, Piccinini, Hay, and Flamant), Centre Hospitalier Intercommunal, Poissy (Dr Fingerhut), Hôpital Henri Mondor (AP-HP), Créteil (Dr Fagniez), and Hôpital Hôtel-Dieu, Clermont-Ferrand (Dr Chipponi), France. A complete list of the surgeons who participated in this study appears above.
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