A prospective study of prophylactic long-acting octreotide in high-risk patients undergoing pancreaticoduodenectomy

Jay A. Graham, Lynt B. Johnson, Naddim Haddad, Firas Al-Kawas, John Carroll, Reena Jha, Jason Wong, Dana Maglaris, Shea Mertens, Thomas Fishbein

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background: Postoperative pancreatic fistula (postoperative pancreatic fistula [POPF]) is the most common complication after pancreaticoduodenectomy. Despite some studies showing little effect of octreotide in unselected patients, we hypothesized that in high-risk patients depot octreotide may reduce the risk of POPF. Methods: Sixty-eight patients were prospectively evaluated for inclusion in the current study. Two groups were identified: pancreatic ducts ≤3 mm (high risk) and those with ducts >3 mm (low risk). Thirty-two patients were low risk, whereas 36 patients were high risk. High-risk patients were treated preoperatively with depot octreotide and begun on an intravenous drip for 24 hours. Low-risk patients underwent pancreaticoduodenectomy without pharmacologic intervention. In contrast, the control cohort represents 106 retrospectively analyzed patients who underwent a pancreaticoduodenectomy without depot octreotide injection without regard to low- or high-risk status. Results: Overall, POPF was 11 of 68 (16%). Nine of 36 high risk patients treated with depot octreotide developed POPF (25%), and 2 of 32 low risk patients developed POPF (6%). In the control cohort of high-risk patients, 9 of 44 (20%) and 3 of 62 (5%) low-risk patients developed POPF (P = .628 when comparing the development of POPF in high-risk patients with or without pharmacologic intervention). Conclusions: Prophylactic use of depot octreotide in high-risk patients does not result in reduced incidence of POPF. Duct size has a significant impact on the occurrence of POPF.

Original languageEnglish (US)
Pages (from-to)481-485
Number of pages5
JournalAmerican Journal of Surgery
Volume201
Issue number4
DOIs
StatePublished - Apr 2011
Externally publishedYes

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Pancreaticoduodenectomy
Octreotide
Pancreatic Fistula
Prospective Studies
Pancreatic Ducts
Intravenous Infusions

Keywords

  • Duct size
  • Octreotide
  • Pancreatic fistula
  • Pancreatoduodenectomy

ASJC Scopus subject areas

  • Surgery

Cite this

A prospective study of prophylactic long-acting octreotide in high-risk patients undergoing pancreaticoduodenectomy. / Graham, Jay A.; Johnson, Lynt B.; Haddad, Naddim; Al-Kawas, Firas; Carroll, John; Jha, Reena; Wong, Jason; Maglaris, Dana; Mertens, Shea; Fishbein, Thomas.

In: American Journal of Surgery, Vol. 201, No. 4, 04.2011, p. 481-485.

Research output: Contribution to journalArticle

Graham, JA, Johnson, LB, Haddad, N, Al-Kawas, F, Carroll, J, Jha, R, Wong, J, Maglaris, D, Mertens, S & Fishbein, T 2011, 'A prospective study of prophylactic long-acting octreotide in high-risk patients undergoing pancreaticoduodenectomy', American Journal of Surgery, vol. 201, no. 4, pp. 481-485. https://doi.org/10.1016/j.amjsurg.2010.06.038
Graham, Jay A. ; Johnson, Lynt B. ; Haddad, Naddim ; Al-Kawas, Firas ; Carroll, John ; Jha, Reena ; Wong, Jason ; Maglaris, Dana ; Mertens, Shea ; Fishbein, Thomas. / A prospective study of prophylactic long-acting octreotide in high-risk patients undergoing pancreaticoduodenectomy. In: American Journal of Surgery. 2011 ; Vol. 201, No. 4. pp. 481-485.
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abstract = "Background: Postoperative pancreatic fistula (postoperative pancreatic fistula [POPF]) is the most common complication after pancreaticoduodenectomy. Despite some studies showing little effect of octreotide in unselected patients, we hypothesized that in high-risk patients depot octreotide may reduce the risk of POPF. Methods: Sixty-eight patients were prospectively evaluated for inclusion in the current study. Two groups were identified: pancreatic ducts ≤3 mm (high risk) and those with ducts >3 mm (low risk). Thirty-two patients were low risk, whereas 36 patients were high risk. High-risk patients were treated preoperatively with depot octreotide and begun on an intravenous drip for 24 hours. Low-risk patients underwent pancreaticoduodenectomy without pharmacologic intervention. In contrast, the control cohort represents 106 retrospectively analyzed patients who underwent a pancreaticoduodenectomy without depot octreotide injection without regard to low- or high-risk status. Results: Overall, POPF was 11 of 68 (16{\%}). Nine of 36 high risk patients treated with depot octreotide developed POPF (25{\%}), and 2 of 32 low risk patients developed POPF (6{\%}). In the control cohort of high-risk patients, 9 of 44 (20{\%}) and 3 of 62 (5{\%}) low-risk patients developed POPF (P = .628 when comparing the development of POPF in high-risk patients with or without pharmacologic intervention). Conclusions: Prophylactic use of depot octreotide in high-risk patients does not result in reduced incidence of POPF. Duct size has a significant impact on the occurrence of POPF.",
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AU - Johnson, Lynt B.

AU - Haddad, Naddim

AU - Al-Kawas, Firas

AU - Carroll, John

AU - Jha, Reena

AU - Wong, Jason

AU - Maglaris, Dana

AU - Mertens, Shea

AU - Fishbein, Thomas

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N2 - Background: Postoperative pancreatic fistula (postoperative pancreatic fistula [POPF]) is the most common complication after pancreaticoduodenectomy. Despite some studies showing little effect of octreotide in unselected patients, we hypothesized that in high-risk patients depot octreotide may reduce the risk of POPF. Methods: Sixty-eight patients were prospectively evaluated for inclusion in the current study. Two groups were identified: pancreatic ducts ≤3 mm (high risk) and those with ducts >3 mm (low risk). Thirty-two patients were low risk, whereas 36 patients were high risk. High-risk patients were treated preoperatively with depot octreotide and begun on an intravenous drip for 24 hours. Low-risk patients underwent pancreaticoduodenectomy without pharmacologic intervention. In contrast, the control cohort represents 106 retrospectively analyzed patients who underwent a pancreaticoduodenectomy without depot octreotide injection without regard to low- or high-risk status. Results: Overall, POPF was 11 of 68 (16%). Nine of 36 high risk patients treated with depot octreotide developed POPF (25%), and 2 of 32 low risk patients developed POPF (6%). In the control cohort of high-risk patients, 9 of 44 (20%) and 3 of 62 (5%) low-risk patients developed POPF (P = .628 when comparing the development of POPF in high-risk patients with or without pharmacologic intervention). Conclusions: Prophylactic use of depot octreotide in high-risk patients does not result in reduced incidence of POPF. Duct size has a significant impact on the occurrence of POPF.

AB - Background: Postoperative pancreatic fistula (postoperative pancreatic fistula [POPF]) is the most common complication after pancreaticoduodenectomy. Despite some studies showing little effect of octreotide in unselected patients, we hypothesized that in high-risk patients depot octreotide may reduce the risk of POPF. Methods: Sixty-eight patients were prospectively evaluated for inclusion in the current study. Two groups were identified: pancreatic ducts ≤3 mm (high risk) and those with ducts >3 mm (low risk). Thirty-two patients were low risk, whereas 36 patients were high risk. High-risk patients were treated preoperatively with depot octreotide and begun on an intravenous drip for 24 hours. Low-risk patients underwent pancreaticoduodenectomy without pharmacologic intervention. In contrast, the control cohort represents 106 retrospectively analyzed patients who underwent a pancreaticoduodenectomy without depot octreotide injection without regard to low- or high-risk status. Results: Overall, POPF was 11 of 68 (16%). Nine of 36 high risk patients treated with depot octreotide developed POPF (25%), and 2 of 32 low risk patients developed POPF (6%). In the control cohort of high-risk patients, 9 of 44 (20%) and 3 of 62 (5%) low-risk patients developed POPF (P = .628 when comparing the development of POPF in high-risk patients with or without pharmacologic intervention). Conclusions: Prophylactic use of depot octreotide in high-risk patients does not result in reduced incidence of POPF. Duct size has a significant impact on the occurrence of POPF.

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KW - Pancreatoduodenectomy

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