Summary
Introduction
Postoperative pancreatic fistulas (POPF) are possible origins of dangerous and life-threatening complications after pancreatic head resections. In 2020, a review with over 52,000 patients showed that patients without secretion inhibition (SI) show a higher tendency to develop a POPF. However, there is still no consensus regarding the use of secretion inhibition or in which way it should be administered. The aim of our study is to show whether SI with somatostatin is superior to inhibition with a somatostatin analogue (SA).
Methods
This retrospective data analysis was retrieved from an existing databank. Between 3/2015 and 12/2018, a total of 66 PDAC patients underwent pancreatic head resection. In this group, somatostatin was used as a perioperative secretion inhibitor. The comparison group (n = 91) operated from 1/2010 to 12/2014 received an SA for inhibition. These groups were compared regarding the occurrence of clinically relevant (CR)-POPF.
Results
The frequency rates for biochemical leakage, type B, and type C fistulas in the SA group were 17.58% (n = 16), 30.76% (n = 28), and 9.89% (n = 9), respectively. The somatostatin group showed the following frequencies: 24.2% (n = 16) for biochemical leakage, 16.7% (n = 11) for type B, and 6.1% (n = 4) for type C fistulas. The overall occurrence of CR-POPF was significantly reduced in the somatostatin group (p = 0.0069).
Conclusion
The perioperative use of somatostatin is superior to the use of a somatostatin analogue for POPF prevention in the context of oncological pancreatic head resections.
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References
Wang X, Li X, Wei X, Jiang H, Lan C, et al. PD-L1 is a direct target of cancer-FOXP3 in pancreatic ductal adenocarcinoma (PDAC), and combined immunotherapy with antibodies against PD-L1 and CCL5 is effective in the treatment of PDAC. Signal Transduct Target Ther. 2020;5(1):38. https://doi.org/10.1038/s41392-020-0144-8.
Christiane J. Bruns. Synopsis—S3 guidelines pancreatic cancer. Chirurg. 2022;93:427–8.
Ouaïssi M, Giger U, Louis G, Sielezneff I, Farges O, et al. Ductal adenocarcinoma of the pancreatic head: a focus on current diagnostic and surgical concepts. World J Gastroenterol. 2012;18(24):3058–69. https://doi.org/10.3748/wjg.v18.i24.3058.
Karunakaran M, Barreto SG. Surgery for pancreatic cancer: current controversies and challenges. Future Oncol. 2021;17(36):5135–62. https://doi.org/10.2217/fon-2021-0533.
Arjunan R, Karthik SDS, Chowdappa R, Althaf S, Srinivas C. Contemporary surgical, oncological, and survival outcomes of pancreaticoduodenectomy for periampullary tumours: a 5-year experience from tertiary cancer center. J Surg Oncol. 2021;12(3):603–10. https://doi.org/10.1007/s13193-021-01385-7.
Bonaroti JW, Zenati MS, Al-Abbas AI, Rieser CJ, et al. Impact of postoperative pancreatic fistula on long-term oncologic outcomes after pancreatic resection. HPB. 2021;23(8):1269–76. https://doi.org/10.1016/j.hpb.2020.12.010.
Dhayat SA, Tamim ANJ, Jacob M, Ebeling G, Kerschke L, Kabar I, Senninger N. Postoperative pancreatic fistula affects recurrence-free survival of pancreatic cancer patients. PLoS One. 2021;16(6):e0252727. https://doi.org/10.1371/journal.pone.0252727.
Søreide K, Healey AJ, Mole DJ, Parks RW. Pre-, peri- and post-operative factors for the development of pancreatic fistula after pancreatic surgery. HPB. 2019;21(12):1621–31. https://doi.org/10.1016/j.hpb.2019.06.004.
Kamarajah SK, Bundred JR, Lin A, Halle-Smith J, Pande R, Sutcliffe R, Harrison EM, Roberts KJ, PARANOIA Study Group. Systematic review and meta-analysis of factors associated with post-operative pancreatic fistula following pancreatoduodenectomy. ANZ J Surg. 2021;91(5):810–21. https://doi.org/10.1111/ans.16408.
van Roessel S, Mackay TM, Tol JAMG, van Delden OM, van Lienden KP, et al. Impact of expanding indications on surgical and oncological outcome in 1434 consecutive pancreatoduodenectomies. HPB. 2019;21(7):865–75. https://doi.org/10.1016/j.hpb.2018.10.020.
Lichun Sun DHC. Somatostatin and its analogs. Curr Drug Targets. 2016;17(5):529–37. https://doi.org/10.2174/1389450116666141205163548.
Patel YC. Somatostatin and its receptor family. Front Neuroendocrinol. 1999;20(3):157–98. https://doi.org/10.1006/frne.1999.0183.
Reisine T. Somatostatin receptors. Am J Physiol. 1995;269(6 Pt 1):G813–G20. https://doi.org/10.1152/ajpgi.1995.269.6.G813.
Harris AG. Somatostatin and somatostatin analogues: pharmacokinetics and pharmacodynamic effects. Gut. 1994;35(3 Suppl):S1–S4. https://doi.org/10.1136/gut.35.3_suppl.s1.
Uhlén M, et al. Tissue-based map of the human proteome. Science. 2015; https://doi.org/10.1126/science.1260419.
Leandros E, Antonakis PT, Albanopoulos K, Dervenis C, Konstadoulakis MM. Somatostatin versus octreotide in the treatment of patients with gastrointestinal and pancreatic fistulas. Can J Gastroenterol. 2004;18(5):303–6. https://doi.org/10.1155/2004/901570.
Popp FC, Bruns CJ. Range of variation of pancreaticojejunostomy in pancreatic head resection. Chirurg. 2017;88(1):3–10. https://doi.org/10.1007/s00104-016-0327-6.
Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M, International Study Group on Pancreatic Fistula Definition. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138:8–13.
Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, Allen P, Andersson R, Asbun HJ, Besselink MG, Conlon K, Del Chiaro M, Falconi M, Fernandez-Cruz L, Fernandez-Del Castillo C, Fingerhut A, Friess H, Gouma DJ, Hackert T, Izbicki J, Lillemoe KD, Neoptolemos JP, Olah A, Schulick R, Shrikhande SV, Takada T, Takaori K, Traverso W, Vollmer CR, Wolfgang CL, Yeo CJ, Salvia R, Buchler M, International Study Group on Pancreatic Surgery (ISGPS). The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After. Surgery. 2017;161:584–91.
Berberat PO, Friess H, Büchler MW. The role of octreotide in the prevention of complications following pancreatic resection. Digestion. 1999;60(suppl 2):15–22. https://doi.org/10.1159/000051476.
Katsourakis A, Zezos P, Noussios G, Kouklakis G, Chatzitheoklitos E, Simopoulos K, Pitiakoudis M. Does prophylactic administration of somatostatin decrease the rates of complications after pancreatic resection?: A clinical and electron microscopy study. Pancreas. 2013;42(1):37–41. https://doi.org/10.1097/MPA.0b013e3182557c24.
Callery MP, Pratt WB, Kent TS, et al. A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy. J Am Coll Surg. 2013;216(1):1–14. https://doi.org/10.1016/j.jamcollsurg.2012.09.002.
Chen J‑Y, Feng J, Wang X‑Q, Cai S‑W, Dong J‑HY-LC. Risk scoring system and predictor for clinically relevant pancreatic fistula after pancreaticoduodenectomy. World J Gastroenterol. 2015;21(19):5926–33. https://doi.org/10.3748/wjg.v21.i19.5926.
Li Y, Zhou F, Zhu D‑M, Zhang Z‑X, Yang J, Yao J, Wei Y‑J, Xu Y‑L, Dei-Chun LJZ. Novel risk scoring system for prediction of pancreatic fistula after pancreaticoduodenectomy. World J Gastroenterol. 2019;25(21):2650–64. https://doi.org/10.3748/wjg.v25.i21.2650.
Schuh F, Mihaljevic AL, Probst P, et al. A simple classification of pancreatic duct size and texture predicts postoperative pancreatic fistula: a classification of the international study group of pancreatic surgery (ISGPS). Ann Surg. 2021; https://doi.org/10.1097/SLA.0000000000004855.
Bertens KA, Crown A, Clanton J, et al. What is a better predictor of clinically relevant postoperative pancreatic fistula (CR-POPF) following pancreaticoduodenectomy (PD): postoperative day one drain amylase (POD1DA) or the fistula risk score (FRS)? HPB. 2017;19(1):75–81. https://doi.org/10.1016/j.hpb.2016.10.001.
Jiang L, Ning D, Xiaoping C. Prevention and treatment of pancreatic fistula after pancreatic body and tail resection: current status and future directions. Front Med. 2020;14(3):251–61. https://doi.org/10.1007/s11684-019-0727-3.
Liu P, Yang Q, Zhu L. The effects of different treatments on postoperative pancreatic fistula (POPF). J Investig Surg. 2020;33(5):491–2. https://doi.org/10.1080/08941939.2018.1529840.
Hank T, Sandini M, Ferrone CR, et al. Association between pancreatic fistula and long-term survival in the era of neoadjuvant chemotherapy. JAMA Surg. 2019;154(10):943–51. https://doi.org/10.1001/jamasurg.2019.2272.
Birnbaum DJ, Bertucci F, Finetti P, Birnbaum D, Mamessier E. Head and body/tail pancreatic carcinomas are not the same tumors. Cancers. 2019;11(4):497. https://doi.org/10.3390/cancers11040497.
Sülberg D, Chromik AM, Köster O, Uhl W. Prävention und Management von postoperativen Komplikationen in der Pankreaschirurgie. Prevention and Management of Postoperative Complications in Pancreatic Surgery. Zentralbl Chir. 2010;135(2):129–38. https://doi.org/10.1055/s-0030-1247317.
Mischinger HJ, Werkgartner G, Kornprat P, Marsoner K, Wagner D, Cerwenka H, Bacher H. Komplikationen in der Pankreaschirurgie. Wien Klin Mag. 2018;21:98–107. https://doi.org/10.1007/s00740-018-0226-1.
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S. Sauseng, A. Imamovic, J. Kresic, T. Niernberger, and H. Rabl declare that they have no competing interests.
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Sauseng, S., Imamovic, A., Kresic, J. et al. Perioperative management of pancreatic excretory function in the context of pancreatic head resections in PDAC patients. Eur Surg 54, 301–308 (2022). https://doi.org/10.1007/s10353-022-00779-3
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DOI: https://doi.org/10.1007/s10353-022-00779-3