Effect of Synthetic Somatostatin on Exocrine Pancreatic Function after Pancreatic Head Resection

Chae, G H; So, B J; Chae, K M

Abstract

BACKGROUND: Inhibition of exocrine pancreatic secretion perioperatively is a promising concept for the prevention of complications, and the suppressive role of synthetic somatostatin on the pancreatic exocrine function has been described. This study was designed to investigate the perioperative effects of synthetic somatostatin(Somatostatin..; Sandoz, Switzerland) on pancreatic exocrine function after major pancreatic resection.
METHODS
In all, 87 patients were evaluated(55 men, 32 women; mean(s.e.m.) age 62.1 years) who had periampullary cancer(68), chronic pancreatitis(11) or trauma(8) and were undergoing pancreatic resection(51 standard pancreaticoduodenectomy, 36 pylorus-preserving pancreaticoduodenectomy). Patients were divided randomly into two groups; Group A(n=56): recieved Sandostatin for 7 days postoperatively, Group B(n=31): without Sandostatin as a control. Pancreatic exocrine function was assessed by determining volume and components of external collection through the pancreatic duct tube and peripancreatic fluid collection via hemovac drain on the 1st, 3rd, 5th, 7th, and 9th postoperative day. We also measured serum amylase levels at the same intervals.
RESULTS
The volume of pancreatic duct drain was significantly reduced in Group A on the 1st and 3rd days and the volume of hemovac drain was also reduced after the 5th postoperative day in Group A(p<0.05) compared to the control group. The levels of amylase were lower in Group A after the 3rd and 5th day, respectively. The serum levels of amylase in Group A returned to normal levels earlier compared with the control group.
CONCLUSION
These results demonstrate that the routine perioperative application of synthetic somatostatin resulted in pancreatic exocrine function suppression, so that pancreatic secretion and peripancreatic fluid collection due to postoperative pancreatic sweating could be significantly prevented after major pancreatic resection. But, large amounts of peripancreatic fluid collection were noticed even in Group A, which suggests need of routine peripancreatic drainage for several days.