Octreotide in the Prevention of Intra-abdominal Complications Following Elective Pancreatic Resection

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Abstract
Mortality and morbidity rates after pancreatic resection range from 0%1 to 10.2%2 and from 20%1 to 40%,3 respectively. The most common major complication is pancreatic fistula,1,3 usually related to persistent pancreatic secretion, which hinders the healing of the pancreatic stump. Octreotide and vapreotide, synthetic somatostatin analogues, inhibit the exocrine secretion of the pancreas4 and therefore might lower the rate of postoperative pancreatic fistula by decreasing the secretion of the pancreatic remnant. Of the 7 large (>100 patients) reported controlled trials5-11 that tested octreotide5-10 or vapreotide11 in this setting, 4 European multicenter studies5-8 have shown a significant decrease in the rate of postoperative intra-abdominal complications (IACs), pancreatic fistula, and extra-abdominal complications (EACs) in patients undergoing pancreatic resection treated with octreotide. On the other hand, the 3 American, high-volume (2 single-center9,10 and 1 multicenter11) studies found no statistically significant difference in the postoperative course between the 2 groups whether or not they were treated with octreotide9,10 or vapreotide.11 Whether and how somatostatin analogues really work, however, remain a matter of debate, because the drugs act not only on pancreatic secretion but also on gastric, biliary, and jejunal secretions and intestinal motility.4 We therefore undertook a large, prospective, multicenter randomized trial to determine whether octreotide acetate decreased the rate of patients with IACs and/or their severity7 and to highlight the patients at risk who might benefit most from this inhibitor of pancreatic secretion.