Abstract
PurposeThis study evaluated the controversial role of somatostatin after pancreatoduodenectomy (PD), stratifying patients for the main risk factors using the most recent postoperative pancreatic fistula (POPF) classification and including only patients who had undergone PD with the same technique of pancreatojejunostomy.MethodsBetween November 2010 and February 2020, 218 PD procedures were carried out via personal modified pancreatojejunostomy (mPJ-PD). Somatostatin was routinely administered between 2010 and 2016, while from 2017, 97 mPJ-PD procedures without somatostatin (WS) were performed. The WS group was retrospectively compared with a control (C) group obtained with one-to-one case–control matching according to the body mass index, American Society of Anesthesiologists’ score, and Fistula Risk Score (FRS).ResultsA total of 144 patients (72 WS group versus 72 C group) were compared. In the WS group. 6 patients (8.3%) developed clinically relevant POPF, compared with 8 patients (11.1%) in the C group (p = 0.656). In addition, on analyzing the subgroup of high-risk patients according to the FRS, we did not note any significant differences in POPF occurrence. Furthermore, no marked differences in the morbidity or mortality were found. Digestive bleeding and diabetes onset rates were higher in the WS group than in the control group, but not significantly so.ConclusionsThe results of the present study confirm no benefit with the routine administration of somatostatin after PD to prevent POPF, even in high-risk patients. However, a possible role in the prevention of postoperative digestive bleeding and diabetes was observed.
Highlights
In recent decades, technical evolution and perioperative management improvements have drastically reduced mortality following pancreatoduodenectomy (PD) in high-volume centers [1]
The baseline characteristics of the entire cohort of patients who had undergone modified invaginated pancreatojejunostomy technique (mPJ)-PD at our institute are shown in Table 1, excluding those of the first 20 who were removed to eliminate possible bias related to the learning curve of the new modified technique
BMI body mass index, American Society of Anesthesiologists’ (ASA) american society of anesthesiologists’ score, Fistula Risk Score (FRS) fistula risk score the subgroups of patients with a high FRS risk, we found no significant difference in the postoperative pancreatic fistula (POPF) occurrence (Table 5)
Summary
Technical evolution and perioperative management improvements have drastically reduced mortality following pancreatoduodenectomy (PD) in high-volume centers [1]. Several studies have demonstrated a correlation between the development of POPF and other patient-related factors, such as high values for the body mass index (BMI) and American Society of Anesthesiologists’ (ASA) score [8]. Since POPF strongly influences both the short- and longterm outcomes following PD [9,10,11,12], various strategies have been adopted in an attempt to reduce the rate of this complication, including the use of fibrin sealants, transanastomotic stents, different techniques for fashioning the pancreatojejunostomy, and the administration of somatostatin analogues (SAs) [13].
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