The role of octreotide in preventing complications after pancreatoduodenectomy for cancer

Background Although the mortality rate of pancreatoduodenectomy has fallen sharply over the last two decades, there is still a risk of serious complications resulting from leakage at the site of anastomosis between the pancreatic remnant and the gastrointestinal tract. Numerous techniques have been described to minimise the risk of these anastomotic leaks, but they can be difficult to avoid if the distal pancreas is unobstructed with a soft parenchyma and a non-dilated duct. The risk of leakage is largely dependent upon the presence of activated pancreatic enzymes, and this fact provides a rationale for the perioperative use of the somatostatin analogue octreotide to inhibit exocrine pancreatic secretion. Discussion Six prospective randomised controlled trials have been published on the use of prophylactic octreotide in pancreatic surgery, five from Europe and one from the USA. The five (multicentre) European studies have consistently shown that octreotide reduces the postoperative complication rate, but the American study does not confirm this benefit. Methodological differences may explain the discrepancy, notably the fact that most of the US patients had received preoperative chemoradiation which is likely to have reduced enzyme secretion. A meta-analysis of four of these studies showed that octreotide lowered the rate of postoperative complications from 37 to 21%, chiefly by reducing the risk of pancreatic fistula. Prophylactic octreotide therapy is cost effective and should be used at least in patients with normal pancreatic parenchyma