The role of somatostatin and octreotide in pancreatic surgery and in acute and chronic pancreatitis

Major pancreatic resection is still accompanied by considerable morbidity (35%) and even mortality (10%). Typical complications such as fistula and abscess are chiefly associated with exocrine Pancreatic secretion, exocrineTherefore, the perioperative inhibition of exocrine pancreatic secretion is apromising concept in the prevention of complications. The hormone somato-statin and its analogue octreotide is well known as a potent inhibitor of exocrine pancreatic secretion. In two randomized, double-blind, placebo-con- trolled multicenter trials we assessed the prophylactic effect of the perioperative inhibition of exocrine pancreatic secretion by octreotide, a long-acting somatostatin analogue, to prevent postoperative complications. Each patient received 3 x 100 pg/day octreotide or placebo subcutaneously. A significant reduction of complications such as fistula, abscess, fluid collection, sepsis and postoperative pancreatitis could be demonstrated in the study with patients undergoing Whipple resection for cancer. In a second study, using the same study protocol recruiting only patients with chronic pancreatitis a significant reduction in the postoperative complication rate was also present in the octreotide group in comparison with the placebo group. In acute pancreatitis activation of digestive enzymes in the pancreas may play an important role. Therefore, inhibition of enzyme secretion also seems to be a useful concept in treating acute pancreatitis. However, it is not clear whether exocrine pancreatic secretion continues in acute pancreatitis. Recently we have started a randomized, controlled multicenter trial in which 300 patients will be treated with or without octreotide in a double-blind fashion. The results of this study will clarify the influence of the inhibition of the exocrine pancreatic secretion by octreotide on the course of acute pancreatitis.