TY - JOUR
T1 - Somatostatin analogues for the prevention of pancreatic fistula after open pancreatoduodenectomy
T2 - A nationwide analysis
AU - Bootsma, Boukje T.
AU - Plat, Victor D.
AU - Dutch Pancreatic Cancer Group
AU - van de Brug, Tim
AU - Huisman, Daitlin E.
AU - Botti, M.
AU - van den Boezem, Peter B.
AU - Bonsing, Bert A.
AU - Bosscha, Koop
AU - Dejong, Cornelis H.C.
AU - Groot-Koerkamp, Bas
AU - Hagendoorn, Jeroen
AU - van der Harst, Erwin
AU - de Hingh, Ignace H.
AU - de Meijer, Vincent E.
AU - Luyer, Misha D.
AU - Nieuwenhuijs, Vincent B.
AU - Pranger, Bobby K.
AU - van Santvoort, Hjalmar C.
AU - Wijsman, Jan H.
AU - Zonderhuis, Barbara M.
AU - Kazemier, Geert
AU - Besselink, Marc G.
AU - Daams, Freek
N1 - Acknowledgement:
Ipsen provided financial support for the conduct of this study. Ipsen was not involved in the study design, collection, analysis or interpretation of data. The content is solely the responsibility of the authors.
Publisher Copyright: © 2022 The Authors
PY - 2022/4
Y1 - 2022/4
N2 - Background: Somatostatin analogues (SA) are currently used to prevent postoperative pancreatic fistula (POPF) development. However, its use is controversial. This study investigated the effect of different SA protocols on the incidence of POPF after pancreatoduodenectomy in a nationwide population. Methods: All patients undergoing elective open pancreatoduodenectomy were included from the Dutch Pancreatic Cancer Audit (2014–2017). Patients were divided into six groups: no SA, octreotide, lanreotide, pasireotide, octreotide only in high-risk (HR) patients and lanreotide only in HR patients. Primary endpoint was POPF grade B/C. The updated alternative Fistula Risk Score was used to compare POPF rates across various risk scenarios. Results: 1992 patients were included. Overall POPF rate was 13.1%. Lanreotide (10.0%), octreotide-HR (9.4%) and no protocol (12.7%) POPF rates were lower compared to the other protocols (varying from 15.1 to 19.1%, p = 0.001) in crude analysis. Sub-analysis in patients with HR of POPF showed a significantly lower rate of POPF when treated with lanreotide (10.0%) compared to no protocol, octreotide and pasireotide protocol (21.6–26.9%, p = 0.006). Octreotide-HR and lanreotide-HR protocol POPF rates were comparable to lanreotide protocol, however not significantly different from the other protocols. Multivariable regression analysis demonstrated lanreotide protocol to be positively associated with a low odds-ratio (OR) for POPF (OR 0.387, 95% CI 0.180–0.834, p = 0.015). In-hospital mortality rates were not affected. Conclusion: Use of lanreotide in all patients undergoing pancreatoduodenectomy has a potential protective effect on POPF development. Protocols for HR patients only might be favorable too. However, future studies are warranted to confirm these findings.
AB - Background: Somatostatin analogues (SA) are currently used to prevent postoperative pancreatic fistula (POPF) development. However, its use is controversial. This study investigated the effect of different SA protocols on the incidence of POPF after pancreatoduodenectomy in a nationwide population. Methods: All patients undergoing elective open pancreatoduodenectomy were included from the Dutch Pancreatic Cancer Audit (2014–2017). Patients were divided into six groups: no SA, octreotide, lanreotide, pasireotide, octreotide only in high-risk (HR) patients and lanreotide only in HR patients. Primary endpoint was POPF grade B/C. The updated alternative Fistula Risk Score was used to compare POPF rates across various risk scenarios. Results: 1992 patients were included. Overall POPF rate was 13.1%. Lanreotide (10.0%), octreotide-HR (9.4%) and no protocol (12.7%) POPF rates were lower compared to the other protocols (varying from 15.1 to 19.1%, p = 0.001) in crude analysis. Sub-analysis in patients with HR of POPF showed a significantly lower rate of POPF when treated with lanreotide (10.0%) compared to no protocol, octreotide and pasireotide protocol (21.6–26.9%, p = 0.006). Octreotide-HR and lanreotide-HR protocol POPF rates were comparable to lanreotide protocol, however not significantly different from the other protocols. Multivariable regression analysis demonstrated lanreotide protocol to be positively associated with a low odds-ratio (OR) for POPF (OR 0.387, 95% CI 0.180–0.834, p = 0.015). In-hospital mortality rates were not affected. Conclusion: Use of lanreotide in all patients undergoing pancreatoduodenectomy has a potential protective effect on POPF development. Protocols for HR patients only might be favorable too. However, future studies are warranted to confirm these findings.
UR - https://www.scopus.com/pages/publications/85126511443
U2 - 10.1016/j.pan.2022.03.006
DO - 10.1016/j.pan.2022.03.006
M3 - Article
C2 - 35304104
AN - SCOPUS:85126511443
SN - 1424-3903
VL - 22
SP - 421
EP - 426
JO - Pancreatology
JF - Pancreatology
IS - 3
ER -
