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Octreotide in the prevention of intra-abdominal complications following elective pancreatic resection: a prospective, multicenter randomized controlled trial
- Source :
- Archives of surgery (Chicago, Ill. : 1960). 139(3)
- Publication Year :
- 2004
-
Abstract
- Prophylactic administration of octreotide acetate decreases the rate of postoperative intra-abdominal complications (IACs) after elective pancreatic resection.Single-blind, controlled, randomized trial.Multicenter (N = 20) trial in France.Of 230 randomized patients undergoing pancreatoduodenectomy and pancreatic enteric anastomosis or distal pancreatectomy for either malignant or benign tumor or chronic pancreatitis, 122 were allotted intraoperatively to receive octreotide; 108 served as controls.All 230 patients were analyzed. Both groups were comparable except that significantly more patients in the octreotide group had biological glue injected into the main pancreatic duct alone (P.001) or reinforcing the pancreatic enteric anastomosis (68% [83/122] vs 39% [42/108]; P =.002). Fewer patients (P =.08) in the octreotide group sustained 1 or more IACs (22% vs 32%). In subgroup analysis, octreotide significantly reduced the rate of patients sustaining 1 or more IACs when the main pancreatic duct diameter was less than 3 mm (P.02), when pancreatojejunostomy was performed (P.02), or both (P.02). No significant differences were found regarding IAC severity. Twenty-three patients (10%) died postoperatively, 16 (70% of deaths) of whom had 1 or more IACs. The only independent risk factor for IACs found on multivariate analysis was pancreatoduodenectomy compared with distal pancreatectomy (P.01) (odds ratio, 3.54 [95% confidence interval, 1.44-8.65]).Our results suggest that octreotide is not necessary for all patients undergoing pancreatic resection; it could be useful when the main pancreatic duct is less than 3 mm in diameter and when pancreatoduodenectomy is completed by pancreatojejunostomy.
- Subjects :
- Adult
Male
medicine.medical_specialty
Adolescent
medicine.medical_treatment
Octreotide acetate
Octreotide
Anastomosis
Statistics, Nonparametric
Postoperative Complications
Gastrointestinal Agents
Risk Factors
medicine
Humans
Prospective Studies
Pancreatitis, chronic
Aged
Pancreatic duct
Aged, 80 and over
Chi-Square Distribution
business.industry
Pancreatic Diseases
Middle Aged
Pancreaticoduodenectomy
medicine.disease
Surgery
medicine.anatomical_structure
Logistic Models
Treatment Outcome
Pancreatitis
Female
Pancreas
business
medicine.drug
Subjects
Details
- ISSN :
- 00040010
- Volume :
- 139
- Issue :
- 3
- Database :
- OpenAIRE
- Journal :
- Archives of surgery (Chicago, Ill. : 1960)
- Accession number :
- edsair.doi.dedup.....e939764fe60919b028f0c4ce58403c85