Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Department of Surgery, Germany.
Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Department of Surgery, Germany.
Pancreatology. 2020 Dec;20(8):1770-1778. doi: 10.1016/j.pan.2020.10.043. Epub 2020 Oct 22.
Postoperative pancreatic fistula/POPF is the most feared complication in pancreatic surgery. Although several systematic reviews investigated the impact of somatostatin analogues on POPF, no stratification was performed regarding type of pancreatic resection (pancreaticoduodenectomy/PD; distal pancreatectomy/DP) and different somatostatin analogues.
This study was planed according to the Preferred-Reporting-Items-for-Systematic -Review-and-Meta-Analysis/PRISMA-guidelines. After screening databases for randomized controlled trials/RCT, studies were stratified into pancreatic resection techniques and data were pooled in meta-analyses containing subgroups of octreotide, somatostatin, lanreotide, pasireotide and vapreotide.
The meta-analysis of studies with a mixed cohort of patients after pancreatic resection revealed a protective effect of somatostatin analogues for morbidity (RR: 0.71, p < .00001) but not for mortality (RR: 1.07, = 0.78) or intra-abdominal abscesses (RR: 1.00, p = 1.00). Moreover, no effect was visible for mortality (RR: 1.57, p = .15), morbidity (RR: 0.87, p = .15) and intra-abdominal abscesses (RR: 0.92, p = .48) after PD. The meta-analysis of patients after PD revealed no impact of somatostatin analogues on POPF (RR: 0.87, p = .19) and clinically relevant POPF (RR: 0.69, p = .30). However, treatment with somatostatin analogues in the mixed cohort showed less POPF (RR: 0.60, p < .00001) and clinically relevant POPF (RR: 0.47, p = .02), which was also the case after DP (RR: 0.41, p = .03).
Somatostatin analogues did not affect POPF and clinically relevant POPF after PD, but seemed to be associated with less POPF after DP. As no sufficiently powered RCT could be identified by the systematic review, further RCTs are urgently needed to investigate the effect of somatostatin analogues after DP.
CRD42018099808.
术后胰瘘（POPF）是胰腺外科最可怕的并发症。尽管有几项系统评价研究了生长抑素类似物对 POPF 的影响，但没有针对胰腺切除术类型（胰十二指肠切除术/PD；胰尾部切除术/DP）和不同生长抑素类似物进行分层。
本研究根据首选报告条目进行系统评价和荟萃分析/PRISMA 指南进行规划。在筛选了随机对照试验/RCT 数据库后，研究根据胰腺切除术技术进行分层，并在包含奥曲肽、生长抑素、兰瑞肽、帕瑞肽和伐普肽亚组的荟萃分析中汇总数据。
对接受胰腺切除术后混合队列患者的研究进行荟萃分析显示，生长抑素类似物对发病率有保护作用（RR：0.71，p<0.00001），但对死亡率（RR：1.07，=0.78）或腹腔脓肿（RR：1.00，p=1.00）没有影响。此外，PD 后死亡率（RR：1.57，p=0.15）、发病率（RR：0.87，p=0.15）和腹腔脓肿（RR：0.92，p=0.48）均无影响。PD 后患者的荟萃分析显示，生长抑素类似物对 POPF（RR：0.87，p=0.19）和临床相关 POPF（RR：0.69，p=0.30）无影响。然而，混合队列中生长抑素类似物的治疗与较低的 POPF（RR：0.60，p<0.00001）和临床相关 POPF（RR：0.47，p=0.02）相关，DP 后也存在这种情况（RR：0.41，p=0.03）。
生长抑素类似物对 PD 后 POPF 和临床相关 POPF 无影响，但似乎与 DP 后 POPF 减少有关。由于系统评价未确定足够有力的 RCT，因此迫切需要进一步的 RCT 来研究 DP 后生长抑素类似物的效果。
CRD42018099808。
