Clinical evaluation of somatostatin use in pancreatic resections: Clinical efficacy or limited benefit?

摘要

Background The benefit of somatostatin for the prevention of pancreatic fistula has been debated widely in the literature. The aim of this study was to evaluate the efficacy of somatostatin in preventing pancreatic fistulas and improving postoperative outcomes after pancreatic resection. Hypothesis Somatostatin improves postoperative outcomes after pancreatectomy. Methods A review was performed of a prospectively collected 2002 patient hepatopancreaticobiliary database. Patients were included if they underwent pancreatectomy between October 1, 2000, and May 16, 2012. Patients received somatostatin prophylactically at the discretion of their surgeon. Data were analyzed using univariate and multivariate analysis to determine if somatostatin had any effect on pancreatic fistula formation, fistula severity, duration of stay, and readmission rates. Results We identified 510 patients who underwent pancreatectomy. Overall, patients 30 (6%) developed postoperative pancreatic fistulas and 27 (5%) fistulas were of clinical significance (grade B or C). Somatostatin was administered prophylactically to 215 (42%) patients, 57 patients (11%) were readmitted; the median duration of stay was 9 days (range, 2-81). Pancreatic fistula developed in 7 patients (3%) who received somatostatin versus 23 (8%) who did not receive somatostatin (P =.031). Among patients receiving somatostatin, 6 fistulas (3%) were of clinical significance versus 21 fistulas (7%) for patients who did not receive somatostatin (P =.031). Readmission occurred in 27 patients (13%) who received somatostatin versus 30 patients (10%) who did not receive somatostatin (P =.398). The median duration of stay was 9 days (range, 2-48) for patients who received somatostatin versus 9 days (range, 2-81) for patients who did not receive somatostatin (P =.462). Conclusion Somatostatin use was associated with a significant decrease in both the rate of fistula formation and the number of clinically important fistulas in our pancreatectomy patients. Continued evaluation of somatostatin use in relation to both intraoperative predictors and costa are needed to better define the population that will gain clinical benefit and cost savings.