The role of pasireotide in developing clinically significant pancreatic fistula

Abstract

Background: Pancreatic surgery has a high rate of morbidity mainly associated with a clinically significant pancreatic fistula types b and c (CSPF). A randomized study showed a reduction in the development of CSPF with the use of pasireotide. The aim of this study is to evaluate the role of pasireotide in patients undergoing pancreatic surgery, to identify factors associated with a CSPF. Methods: A retrospective analysis of our prospectively collected data base of pancreatic surgery between 2013 and 2018 was performed. Patients with total pancreatectomy were excluded from the analysis. Included patients were divided into Group A (treated with 0.9 mg subcutaneous pasireotide BID) and Group B (without pasireotide). Clavien-Dindo classification was used to assess 90-day perioperative morbidity. The incidence and factors associated with the development of a CSPF were evaluated using uni and multi-variate analysis in Stata 14 (StataCorp, TX). Results: During the analyzed 132 patients were operated on 74 women (56%) with a median age of 59 (16 - 87). The main diagnoses were ductal adenocarcinoma (n = 27) and neuroendocrine tumor (n = 24). 79 patients had a PDD (60%). Grade ≥ 3 morbidity occurred in 40 (30%) of then; Group A n: 16 (22%) vs group B n: 24 (41%). Type b-c fistula were presented in 18 patients (13,6%), group A n: 7 (10%) vs group B: 11 (19%) (p = 0.20). The wirsung size of less than 4 mm was related to the presence of type b y c fistula (p = 0.03). Patients with soft pancreas had less incidence of CSPF 3 (9%) in Group A vs 8 (16%) in Group B (p = 0.49). No relation was found between the nutritional status and the development of fistulas (p = 0.38). 90 days mortality was 3%. A multivariate analysis did not show any significant factor associated with CSPF, except the wirsung size. Conclusion: The use of pasireotide was associated with decreasing the risk of CSPF and a lower rate of grade ≥ 3 complications. However, this affirmation was not significant probably by the non number of patients evaluated.