Pancreas

Cohort

Surgery

Pancreaticoduodenectomy

Acromegaly

Somatostatin

Pancreatic fistula

Pasireotide

Internal medicine

Clinical endpoint

Fistula

Hormone

Growth hormone

Medicine

Gastroenterology

General surgery

Randomized controlled trial

Background: Pasireotide, a somatostatin analogue, aims to reduce the risk of pancreatic fistula after pancreatoduodenectomy. Based on a reduced fistula rate (9 vs. 21%, p=0.006) in a randomized trial, we started the use of postoperative pasireotide twice daily for 7 days after pancreatoduodenectomy. Methods: All consecutive patients who underwent pancreatoduodenectomy from 2012 to 2018 were analyzed. Transition to pasireotide was in February 2015. The primary endpoint was the development of an International Study Group on Pancreatic Fistula (ISGPF) grade B or C fistula. Multivariable analysis was performed for pancreatic fistula with adjustment for BMI, duct size, and pancreatic texture (hard/fibrotic versus soft/normal). Results: During this 6-year period, 387 patients underwent pancreatoduodenectomy; 143 patients (37%) before and 244 patients (63%) after pasireotide introduction. Most patients (83%) underwent an open pancreatoduodenectomy and in most patients (98%) 1 or 2 drains were left. In total, 227 patients (93%) received at least one dosage of pasireotide. The median number of pasireotide dosage was 14 (IQR: 9 - 14). Pasireotide was mostly (67%) discontinued early because of nausea and vomiting. Grade B or C fistula occurred in 28 patients (20%) before versus 51 patients (21%) after pasireotide introduction with an unadjusted Odds Ratio (OR) of 1.09 (95% CI: 0.65 - 1.82) and an adjusted OR of 1.16 (95% CI: 0.64 - 2.09). Conclusions: The rate of clinical relevant pancreatic fistula did not change after introduction of pasireotide prophylaxis following pancreatoduodenectomy.

Pasireotide for the prevention of pancreatic fistula after pancreatoduodenectomy: comparison with a historical cohort