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Meta-Analysis
. 2013 Apr 30;2013(4):CD008370.
doi: 10.1002/14651858.CD008370.pub3.

Somatostatin analogues for pancreatic surgery

Kurinchi Selvan Gurusamy  1 , Rahul Koti, Giuseppe Fusai, Brian R Davidson
Affiliations
Meta-Analysis

Somatostatin analogues for pancreatic surgery

Kurinchi Selvan Gurusamy et al. Cochrane Database Syst Rev. .

Abstract

Background: Pancreatic resections are associated with high morbidity (30% to 60%) and mortality (5%). Synthetic analogues of somatostatin are advocated by some surgeons to reduce complications following pancreatic surgery; however, their use is controversial.

Objectives: To determine whether prophylactic somatostatin analogues should be used routinely in pancreatic surgery.

Search methods: We searched the Cochrane Upper Gastrointestinal and Pancreatic Diseases Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 1), MEDLINE, EMBASE and Science Citation Index Expanded to February 2013.

Selection criteria: We included randomised controlled trials comparing prophylactic somatostatin or one of its analogues versus no drug or placebo during pancreatic surgery (irrespective of language or publication status).

Data collection and analysis: Two review authors independently assessed trials for inclusion and independently extracted data. We analysed data with both the fixed-effect and random-effects models using Review Manager (RevMan). We calculated the risk ratio (RR), mean difference (MD) or standardised mean difference (SMD) with 95% confidence intervals (CI) based on an intention-to-treat or available case analysis. When it was not possible to perform either of the above, we performed a per protocol analysis.

Main results: We identified 21 trials (19 trials of high risk of bias) involving 2348 people. There was no significant difference in the perioperative mortality (RR 0.80; 95% CI 0.56 to 1.16; n = 2210) or the number of people with drug-related adverse effects between the two groups (RR 2.09; 95% CI 0.83 to 5.24; n = 1199). Quality of life was not reported in any of the trials. The overall number of participants with postoperative complications was significantly lower in the somatostatin analogue group (RR 0.70; 95% CI 0.61 to 0.80; n = 1903) but there was no significant difference in the re-operation rate (RR 1.26; 95% CI 0.58 to 2.70; n = 687) or hospital stay (MD -1.29 days; 95% CI -2.60 to 0.03; n = 1314) between the groups. The incidence of pancreatic fistula was lower in the somatostatin analogue group (RR 0.66; 95% CI 0.55 to 0.79; n = 2206). The proportion of these fistulas that were clinically significant was not mentioned in most trials. On inclusion of trials that clearly distinguished clinically significant fistulas, there was no significant difference between the two groups (RR 0.69; 95% CI 0.38 to 1.28; n = 292).

Authors' conclusions: Somatostatin analogues may reduce perioperative complications but do not reduce perioperative mortality. Further adequately powered trials with low risk of bias are necessary. Based on the current available evidence, somatostatin and its analogues are recommended for routine use in people undergoing pancreatic resection.

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Conflict of interest statement

None.

Figures

1
1
Study flow diagram.
2
2
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
3
3
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
4
4
Funnel plot of comparison: 1 Somatostatin analogues versus none, outcome: 1.1 Perioperative mortality.
1.1
1.1. Analysis
Comparison 1 Somatostatin analogues versus none, Outcome 1 Perioperative mortality.
1.2
1.2. Analysis
Comparison 1 Somatostatin analogues versus none, Outcome 2 Treatment withdrawal.
1.3
1.3. Analysis
Comparison 1 Somatostatin analogues versus none, Outcome 3 Number with adverse effects due to treatment.
1.4
1.4. Analysis
Comparison 1 Somatostatin analogues versus none, Outcome 4 Re‐operation.
1.5
1.5. Analysis
Comparison 1 Somatostatin analogues versus none, Outcome 5 Anastomotic leak.
1.6
1.6. Analysis
Comparison 1 Somatostatin analogues versus none, Outcome 6 Pancreatic fistula (all).
1.7
1.7. Analysis
Comparison 1 Somatostatin analogues versus none, Outcome 7 Pancreatic fistula (clinically significant).
1.8
1.8. Analysis
Comparison 1 Somatostatin analogues versus none, Outcome 8 Postoperative pancreatitis.
1.9
1.9. Analysis
Comparison 1 Somatostatin analogues versus none, Outcome 9 Sepsis.
1.10
1.10. Analysis
Comparison 1 Somatostatin analogues versus none, Outcome 10 Renal failure.
1.11
1.11. Analysis
Comparison 1 Somatostatin analogues versus none, Outcome 11 Bleeding.
1.12
1.12. Analysis
Comparison 1 Somatostatin analogues versus none, Outcome 12 Abdominal collections.
1.13
1.13. Analysis
Comparison 1 Somatostatin analogues versus none, Outcome 13 Infected abdominal collections.
1.14
1.14. Analysis
Comparison 1 Somatostatin analogues versus none, Outcome 14 Delayed gastric emptying.
1.15
1.15. Analysis
Comparison 1 Somatostatin analogues versus none, Outcome 15 Pulmonary complications.
1.16
1.16. Analysis
Comparison 1 Somatostatin analogues versus none, Outcome 16 Shock.
1.17
1.17. Analysis
Comparison 1 Somatostatin analogues versus none, Outcome 17 Number of complications.
1.18
1.18. Analysis
Comparison 1 Somatostatin analogues versus none, Outcome 18 Number with any complication.
1.19
1.19. Analysis
Comparison 1 Somatostatin analogues versus none, Outcome 19 Hospital stay.
2.1
2.1. Analysis
Comparison 2 Somatostatin analogues versus none (stratified by different interventions), Outcome 1 Perioperative mortality.
2.2
2.2. Analysis
Comparison 2 Somatostatin analogues versus none (stratified by different interventions), Outcome 2 Treatment withdrawal.
2.3
2.3. Analysis
Comparison 2 Somatostatin analogues versus none (stratified by different interventions), Outcome 3 Number with adverse effects due to treatment.
3.1
3.1. Analysis
Comparison 3 Somatostatin analogues versus none (stratified by different aetiologies), Outcome 1 Perioperative mortality.
3.2
3.2. Analysis
Comparison 3 Somatostatin analogues versus none (stratified by different aetiologies), Outcome 2 Treatment withdrawal.
3.3
3.3. Analysis
Comparison 3 Somatostatin analogues versus none (stratified by different aetiologies), Outcome 3 Number with adverse effects due to treatment.
4.1
4.1. Analysis
Comparison 4 Somatostatin analogues versus none (pancreatoduodenectomy), Outcome 1 Perioperative mortality.
4.2
4.2. Analysis
Comparison 4 Somatostatin analogues versus none (pancreatoduodenectomy), Outcome 2 Treatment withdrawal.
4.3
4.3. Analysis
Comparison 4 Somatostatin analogues versus none (pancreatoduodenectomy), Outcome 3 Number with adverse effects due to treatment.
See this image and copyright information in PMC

Update of

References

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