Somatostatin administration following pancreatoduodenectomy: a case-matched comparison according to surgical technique,
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ORIGINAL ARTICLE
Somatostatin administration following pancreatoduodenectomy: a case‑matched comparison according to surgical technique, body mass index, American Society of Anesthesiologists’ score and Fistula Risk Score Niccolò Furbetta1 · Desirée Gianardi1 · Simone Guadagni1 · Gregorio Di Franco1 · Matteo Palmeri1 · Matteo Bianchini1 · Kevin Pisani1 · Giulio Di Candio1 · Luca Morelli1,2 Received: 27 July 2020 / Accepted: 20 October 2020 © The Author(s) 2020
Abstract Purpose This 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. Methods Between 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). Results A 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. Conclusions The 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. Keywords Somatostatin analogues · Pancreatoduodenectomy · Somatostatin prophylaxis · POPF
Introduction In recent decades, technical evolution and perioperative management improvements have drastically reduced mortality following pancreatoduodenectomy (PD) in high-volume centers [1]. However, morbidity rates remain as high * Luca Morelli [email protected] 1
General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56125 Pisa, Italy
EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Pisa, Italy
2
as 28–58%, with post-operative pancreatic fistula (POPF) still the main cause of this high morbidity rate, showing a reported incidence of 2–42.5% [2]. The differences in the incidence of POPF may be due to the varying definitions reported in published studies. Indeed, in 2005, the International Study Group on
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