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Review
. 2010 Apr;12(3):155-65.
doi: 10.1111/j.1477-2574.2010.00157.x.

Meta-analysis of randomized controlled trials on the effectiveness of somatostatin analogues for pancreatic surgery: a Cochrane review

Rahul S Koti  1 , Kurinchi S Gurusamy, Giuseppe Fusai, Brian R Davidson
Affiliations
Review

Meta-analysis of randomized controlled trials on the effectiveness of somatostatin analogues for pancreatic surgery: a Cochrane review

Rahul S Koti et al. HPB (Oxford). 2010 Apr.

Abstract

Background: The use of synthetic analogues of somatostatin following pancreatic surgery is controversial. The aim of this meta-analysis is to determine whether prophylactic somatostatin analogues (SAs) should be used routinely in pancreatic surgery.

Methods: Randomized controlled trials were identified from the Cochrane Library Trials Register, MEDLINE, EMBASE, Science Citation Index Expanded and reference lists. Data were extracted from these trials by two independent reviewers. The risk ratio (RR), mean difference (MD) and standardized mean difference (SMD) were calculated with 95% confidence intervals (95% CIs) based on intention-to-treat or available case analysis.

Results: Seventeen trials involving 2143 patients were identified. The overall number of patients with postoperative complications was lower in the SA group (RR 0.71, 95% CI 0.62-0.82), but there was no difference between the groups in perioperative mortality (RR 1.04, 95% CI 0.68-1.59), re-operation rate (RR 1.15, 95% CI 0.56-2.36) or hospital stay (MD -1.04 days, 95% CI -2.54 to 0.46). The incidence of pancreatic fistula was lower in the SA group (RR 0.64, 95% CI 0.53-0.78). The proportion of these fistulas that were clinically significant is not clear. Analysis of results of trials that clearly distinguished clinically significant fistulas revealed no difference between the two groups (RR 0.69, 95% CI 0.34-1.41). Subgroup analysis revealed a shorter hospital stay in the SA group than among controls for patients with malignant aetiology (MD -7.57 days, 95% CI -11.29 to -3.84).

Conclusions: Somatostatin analogues reduce perioperative complications but do not reduce perioperative mortality. However, they do shorten hospital stay in patients undergoing pancreatic surgery for malignancy. Further adequately powered trials of low risk of bias are necessary.

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Figures

Figure 1
Figure 1
Flow chart showing the search strategy used to identify trials. RCT, randomized controlled trial
Figure 2
Figure 2
Comparison of somatostatin analogues vs. no intervention showing effects on (A) perioperative mortality, (B) re-operation rates and (C) hospital stay. M-H, Mantel-Haenszel; 95% CI, 95% confidence interval, SD, standard deviation
Figure 4
Figure 4
Comparison of somatostatin analogues vs. no intervention showing effects on perioperative complications. (A) Number of complications. (B) Number with any complications. SE, standard error; M-H, Mantel-Haenszel; 95% CI, 95% confidence interval
Figure 3
Figure 3
Comparison of somatostatin analogues vs. no intervention showing effects on pancreatic fistula rates. (A) Pancreatic fistula (all): studies did not differentiate between clinically significant and clinically insignificant fistulas. (B) Pancreatic fistula (clinically significant): studies included only clinically significant fistulas. M-H, Mantel-Haenszel; 95% CI, 95% confidence interval
Figure 5
Figure 5
Comparison of somatostatin analogues vs. no intervention. Subgroup analysis stratified by different aetiologies: effects on hospital stay. SD, standard deviation; 95% CI, 95% confidence interval
Figure 6
Figure 6
Funnel plots of comparison of somatostatin analogues vs. no intervention for outcomes (A) perioperative mortality and (B) re-operation. SE, standard error; RR, risk ratio
See this image and copyright information in PMC

References

    1. Alexakis N, Halloran C, Raraty M, Ghaneh P, Sutton R, Neoptolemos JP. Current standards of surgery for pancreatic cancer. Br J Surg. 2004;91:1410–1427. - PubMed
    1. Gouma DJ, van Geenen RC, van Gulik TM, de Haan RJ, de Wit LT, Busch OR, et al. Rates of complications and death after pancreaticoduodenectomy: risk factors and the impact of hospital volume. Ann Surg. 2000;232:786–795. - PMC - PubMed
    1. Sohn TA, Yeo CJ, Cameron JL, Koniaris L, Kaushal S, Abrams RA, et al. Resected adenocarcinoma of the pancreas–616 patients: results, outcomes, and prognostic indicators. J Gastrointest Surg. 2000;4:567–579. - PubMed
    1. Connor S, Alexakis N, Garden OJ, Leandros E, Bramis J, Wigmore SJ. Meta-analysis of the value of somatostatin and its analogues in reducing complications associated with pancreatic surgery. Br J Surg. 2005;92:1059–1067. - PubMed
    1. Harris AG. Somatostatin and somatostatin analogues: pharmacokinetics and pharmacodynamic effects. Gut. 1994;35(Suppl. 3):1–4. - PMC - PubMed

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