Somatostatin analogues and the risk of post-operative pancreatic fistulas after pancreatic resection - A systematic review & meta-analysis

• Published in: Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] Vol. 20; no. 2; pp. 158 - 168
• Main Authors: Li, Tianpei, D’Cruz, Reuban Toby, Lim, Sheng Yang, Shelat, Vishal G.
• Format: Journal Article
• Language: English
• Published: Switzerland Elsevier B.V 01.03.2020; Elsevier Limited
• Subjects: Abdomen; Bias; Clinical trials; Distal pancreatectomy; Fistula; Humans; Incidence; Literature reviews; Meta-analysis; Morbidity; Mortality; Octreotide; Pancreas; Pancreas - surgery; Pancreatic fistula; Pancreatic Fistula - epidemiology; Pancreatic Fistula - etiology; Pancreatic Fistula - prevention & control; Pancreatic resection; Pancreaticoduodenectomy; Pancreatitis; Pasireotide; Post-operative; Postoperative Complications - epidemiology; Postoperative Complications - prevention & control; Prophylaxis; Risk Assessment; Somatostatin; Somatostatin - analogs & derivatives; Somatostatin - therapeutic use; Somatostatin analogues; Studies; Surgery; Systematic review; Tumors; Whipple’s procedure; Somatostatin analogues; Pancreatic resection; Octreotide; Distal pancreatectomy; Post-operative; Pancreaticoduodenectomy; Pasireotide; Pancreatic fistula; Whipple’s procedure
• ISSN: 1424-3903; 1424-3911
• DOI: 10.1016/j.pan.2019.12.015

Post-operative pancreatic fistula (POPF) is a common complication of pancreatic resection. Somatostatin analogues (SA) have been used as prophylaxis to reduce its incidence. The aim of this study is to appraise the current literature on the effects of SA prophylaxis on the prevention of POPF following pancreatic resection. The review of the literature was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data from studies that reported the effects of SA prophylaxis on POPF following pancreatic resection were extracted, to determine the effect of SA on POPF morbidity and mortality. A total of 15 studies, involving 2221 patients, were included. Meta-analysis revealed significant reductions in overall POPF (Odds ratio: 0.65 (95% CI 0.53–0.81, p < 0.01)), clinically significant POPF (Odds ratio: 0.53 (95% CI 0.34–0.83, p < 0.01)) and overall morbidity (OR: 0.69 (95% CI: 0.50–0.95, p = 0.02)) following SA prophylaxis. There is no evidence that SA prophylaxis reduces mortality (OR: 1.10 (95%CI: 0.68–1.79, p = 0.68)). SA prophylaxis following pancreatic resection reduces the incidence of POPF. However, mortality is unaffected.