Secretin Infusion to Prevent Pancreatic Leaks Following Pancreatic Resection
Status:
Completed
Trial end date:
2019-09-21
Target enrollment:
Participant gender:
Summary
Pancreatic leaks complicate pancreatic resection in approximately 20% of cases. The
pancreatic anastomosis or repair has been referred to as the Achilles heel of pancreatic
surgery. Unfortunately, despite recognition of this problem and multiple operative techniques
proposed to prevent this complication, leaks continue to represent a major cause of morbidity
for patients undergoing pancreatic surgery. Treatment of leaks often requires nutritional
support with total parenteral nutrition to diminish the leak in addition to invasive
interventions to contain the leak with drains, stents or in severe cases, reoperation.
Experiential data suggest that intra-operative infusions of secretin, a naturally occurring
hormone that stimulates bicarbonate release from the pancreas, following resection but just
prior to abdomen closure, may identify a leak if present. If secretin can demonstrate
evidence of leaking intra-operatively, the pancreatic duct leak may be able to be fixed prior
to abdominal closure. The investigators aim to determine if giving an intra-operative
infusion of secretin will allow for identification and treatment of leaks after pancreatic
reconstruction and prior to abdominal closure, leading to a reduction in the rate of
pancreatic anastomotic leaks requiring intervention. The investigators will perform a
double-blind, randomized pilot study of 176 patients undergoing pancreatic resection
(pancreaticoduodenectomy and distal pancreatectomy) at Dartmouth-Hitchcock Medical Center. 88
of those patients will receive an intra-operative secretin infusion prior to abdominal
closure and 88 will receive a saline placebo. Our primary outcome of interest will be the
rate of pancreas duct leaks in each group as measured by the concentration of amylase present
in the surgical drains 3 days following surgery.