The role of octreotide in the prevention of complications following pancreatic resection

Postoperative complications following major pancreatic surgery are mainly d ue to the difficulties of performing a safe and proper anastomosis between the stomach or small bowel and the pancreas. Continuous pancreatic juice se cretion and the often soft structure of the pancreatic parenchyma are major risk factors. The present paper summarizes the results of six previously published, place bo-controlled, double-blind trials and one open randomized trial analyzing the efficacy of octreotide in preventing postoperative complications in pat ients who undergo major pancreatic surgery. Patients were given either octr eotide (3 x 100-150 mu g subcutaneously/day) or a placebo perioperatively f or 5-7 days starting at least 1 h before operation. The patients were monit ored postoperatively for typical postoperative complications such as: leaka ge of the anastomosis, pancreatic fistula, abscess, fluid collection, shock , sepsis, pulmonary insufficiency, renal insufficiency, bleeding, postopera tive pancreatitis, and death. Six of the seven studies showed significantly fewer postoperative complicat ions in the octreotide group in comparison with the placebo group (p <0.05) , The effectiveness of octreotide was most apparent in the prevention of se cretion-related complications such as fistula, fluid collection and leakage of the anastomosis. These studies demonstrated that inhibition of perioperative pancreatic secr etion is a viable treatment concept in patients undergoing major pancreatic surgery. The perioperative and prophylactic application of octreotide in p atients who undergo major pancreatic resection reduces the postoperative co mplication rate significantly.