Garg Pankaj Kumar, Sharma Jyoti, Jakhetiya Ashish, Chishi Nilokali
Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, New Delhi, Delhi, India.
Department of Surgical Oncology, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India.
Surg J (N Y). 2018 Oct 18;4(4):e182-e187. doi: 10.1055/s-0038-1675359. eCollection 2018 Oct.
A postoperative pancreatic fistula (POPF) is a major cause of morbidity and mortality following pancreaticoduodenectomy (PD). A pharmacologic approach using perioperative octreotide, a long-acting somatostatin analog having an inhibitory action on pancreatic exocrine secretion, was proposed to reduce the incidence of the POPF. Despite contradictory results in various randomized controlled trials (RCTs), the prophylactic octreotide has been widely used in the last two decades to reduce the POPF. The present meta-analysis aims to assess the effectiveness of the prophylactic octreotide in preventing the POPF following PD. A literature search was performed in the PubMed for the RCTs that compared the prophylactic octreotide with the placebo following PD published prior to October 2016. Review manager (Cochrane Collaboration's software) version RevMan 5.2 was used for analysis. Those RCTs which had compared the prophylactic Octreotide with placebo to reduce the POPF following PD were considered eligible for the meta-analysis. The low quality (Jadad score of two or less) RCTs or those including mixed pancreatic resections without reporting specific pancreaticoduodenectomy outcomes were excluded. The effect size for the dichotomous and the continuous data was displayed as the odds ratio (OR) and the weighted mean difference (WMD), respectively, with their corresponding 95% confidence intervals (CI). A fixed effect or random effects model was used to pool the data according to the result of a statistical heterogeneity test. The heterogeneity between the studies was evaluated using the Cochran Q statistic and the test, with < 0.05 indicating significant heterogeneity. There were eight RCTs available for the analysis. A total of 959 patients were included in the meta-analysis-492 received the prophylactic octreotide and 467 patients received the placebo. The prophylactic octreotide was not found to significantly decrease the total number of the POPF (OR, 1.03'; 95% CI: 0.73-1.45; -value 0.85) or the clinically significant POPF (OR, 0.76; 95% CI: 0.35-1.65; -value 0.49) compared with the placebo. There was also no difference in the duration of hospital stay (WMD, 1.19; 95% CI:1.84-4.23; -value 0.44) or the postoperative mortality (OR, 2.04; 95% CI: 0.87-4.78; -value 0.10) between the two groups. The prophylactic octreotide was also not found to significantly delay the gastric emptying (OR, 0.76; 95% CI: 0.41-1.40; -value 0.38). The present meta-analysis does not support the role of the prophylactic octreotide to prevent the POPF following PD.
术后胰瘘（POPF）是胰十二指肠切除术（PD）后发病和死亡的主要原因。有人提出采用围手术期使用奥曲肽的药物治疗方法，奥曲肽是一种长效生长抑素类似物，对胰腺外分泌具有抑制作用，以降低POPF的发生率。尽管在各种随机对照试验（RCT）中结果相互矛盾，但在过去二十年中，预防性使用奥曲肽已被广泛用于降低POPF的发生率。本荟萃分析旨在评估预防性使用奥曲肽预防PD后POPF的有效性。
在PubMed中对2016年10月之前发表的比较PD后预防性使用奥曲肽与安慰剂的RCT进行了文献检索。使用Review Manager（Cochrane协作网软件）RevMan 5.2版本进行分析。那些比较预防性使用奥曲肽与安慰剂以降低PD后POPF的RCT被认为符合荟萃分析的条件。排除低质量（Jadad评分小于或等于2分）的RCT或那些包括混合胰腺切除术且未报告特定胰十二指肠切除术后结果的研究。二分类数据和连续数据的效应大小分别表示为比值比（OR）和加权平均差（WMD），并伴有相应的95%置信区间（CI）。根据统计异质性检验的结果，使用固定效应或随机效应模型汇总数据。使用Cochran Q统计量和I²检验评估研究之间的异质性，I²<0.05表示存在显著异质性。
共有八项RCT可用于分析。荟萃分析共纳入959例患者，其中492例接受预防性奥曲肽治疗，467例接受安慰剂治疗。与安慰剂相比，未发现预防性使用奥曲肽能显著降低POPF的总数（OR，1.03；95%CI：0.73 - 1.45；P值0.85）或临床显著的POPF（OR，0.76；95%CI：0.35 - 1.65；P值0.49）。两组在住院时间（WMD，1.19；95%CI：1.84 - 4.23；P值0.44）或术后死亡率（OR，2.04；95%CI：0.87 - 4.78；P值0.10）方面也没有差异。也未发现预防性使用奥曲肽会显著延迟胃排空（OR，0.76；95%CI：0.41 - 1.40；P值0.38）。
本荟萃分析不支持预防性使用奥曲肽预防PD后POPF的作用。
