THE ROUTINE USE OF SOMATOSTATIN ANALOGUES AFTER PANCREATODUODENECTOMY: ITS CLINICAL IMPACT BASED ON A CASE-MATCHED COMPARISON ACCORDING TO FISTULA RISK SCORE, ASA AND SURGICAL TECHNIQUE

Background. The routine use of somatostatin in prevention of post-operative pancreatic fistula (POPF) is controversial. The aim of this study is to compare the incidence of POPF after pancreatoduodenectomy (PD) performed with the same pancreatojejunostomy technique, with and without the postoperative use of somatostatin. Methods. Between November 2010 and October 2018, 152 PD were carried out with a personal, modified invaginated pancreatojejunostomy technique (mPJ-PD). Somatostatin was routinely administered after mPJ-PD between November 2010 and December 2016, while from January 2017 to October 2018, 52 mPJ-PD without somatostatin (WS) were performed. The WS-group was retrospectively compared with a control (C) group obtained with a one-to-one case-control match, according to Fistula Risk Score (FRS) and American Society of Anesthesiologists’ (ASA) score. The postoperative outcomes of the two groups were compared. Results. 104 cases (52 WS-group versus 52 C-group) were compared. In the WS-group 12 patients developed POPF (9 biochemical leak (BL) and 3 Grade B fistulas) versus 15 patients in the C-group (11 BL, 3 Grade B and 1 Grade C), (p=0.7). No difference was found between C-group and WS-group in terms of length of hospital stay (18.6 days versus 19.1 days, p=0.7) and 30-days mortality (3 versus 2 cases; p=0.6). Conclusion. The development of POPF after PD is due to multiple factors including pancreatic texture, pancreatic duct diameter and surgical technique and is not significantly influenced by the post-operative administration of somatostatin. Our results do not support the routinely use of somatostatin for the prevention of POPF after PD.