Somatostatin analogues for reducing complications following pancreatic surgery

Pancreatic resections are associated with high morbidity (30% to 60%) and mortality (5%). It is not clear whether routine, preventative use of synthetic analogues of somatostatin (a hormone which inhibits pancreatic secretions) could reduce complications following pancreatic surgery. We included 17 randomised clinical trials in this review. All trials had high risk of bias ('systematic error'). A total of 2143 patients were randomised either to somatostatin analogues or a control in the 17 trials. The overall number of patients with postoperative complications was lower by 29% in the somatostatin analogues group but there was no difference in postoperative mortality, re-operation rate or overall length of hospital stay between the groups. Pancreatic fistula is drainage of pancreatic juice secreted by the remaining pancreas to the exterior. This was lower in the intervention group by 36%. The proportion of these fistulas that resulted in change to the treatment given to the patients is not clear. When we included trials that clearly distinguished fistulas that required change to the treatment given to the patients, there was no difference between the two groups. In a subgroup analysis we found a shorter hospital stay (by seven days on an average) in the somatostatin analogue group than in controls, where patients were undergoing pancreatic surgery for cancer. In conclusion, somatostatin analogues reduce the incidence of pancreatic fistula and in those undergoing pancreatic surgery for cancer, they shorten hospital stay. Further trials with sufficient patient numbers and a low risk of bias are necessary. Based on the current available evidence, somatostatin and its analogues are recommended for routine use in patients undergoing pancreatic resection for cancer. There is currently no evidence to support their routine use in pancreatic surgeries performed for other reasons.