Background Pancreatoduodenectomy (PD) is one of the mosta technically demanding operationschallenging procedure. In recent decades, mortality has reduced in high-volume centers thanks to technical evolution and perioperative management improvements . Post-operative pancreatic fistula (POPF) still remainsis the main cause of morbidity, with a reported ranging incidence from 2% to 42.5% reported in literature. Most of POPF are successfully treated resolve with conservative management,, and only a small percentage requires percutaneous drainage or surgical operation. The routine use administration of somatostatin in POPF prevention of POPF is controversial and several works have shown no beneficial effects in this setting. The aim of this study is to compare the incidence of fistula in patients who underwent PD with the same pancreatojejunostomy technique, with and without the postoperative use of somatostatin. Methods Between October 2008 and October 2018, A total of 493 pancreatic resections were performed at the our General Surgery Unit, University of Pisa between October 2008 and October 2018.; Among these, 259 were PD, 152 of which 152 were carried out with a personal, modified invaginatedion pancreatojejunostomy technique (mPJ), introduced on November 2010. Somatostatin was routinely administered after PD with mPJ technique (mPJ-PD) between November 2010 and December 2016, while from January 2017 to October 2018, 52 consecutive mPJ-PD without somatostatin (WS) were performed. The WS-group was retrospectively compared with a control (C) group of mPJ in whichwith a postoperative routine administration of somatostatin was routinely used. The two groups were matched using a one-to-one case-control methoddesign, based onaccording to Fistula Risk Score (FRS) and American Society of Anesthesiologists’ (ASA) score. The post operative outcomes of the two groups were compared, with a particular attention to POPF. Patients data were retrieved from the Institutional prospectively collected dedicated database. Results The study sample consists incounts 104 patients (52 WS-group versus 52 C-for each group). In both groups the FRS was graded as following: FRS=0, 3.8%; FRS=1-2, 19.2%; FRS=3-6, 61.5%; FRS=7-10, 15.4%. No difference was found in term of operative time (430.38  79.18 min in C-group versus 413.17  72.28 min in WS-group, p=0.8) and length of hospital stay (18.6 days in C-group vs 19.1 days in WS-group, p=0.7). In the WS-group, POPF occurred was registered in 12 patients: 9 were biochemical leaks (BL) and 3 were Grade B fistulas, whereas in the C-group 15 patients developed POPF (11 BL, 3 Grade B and 1 Grade C), without any significant difference between the two groups (p=0.7). No difference was documented for 30-days mortality (2 cases in WS-group versus 3 cases in BC-group; p=0.6). Conclusion Multiple factors are involved in tThe development of POPF after PD, such as is due to multiple factors including pancreatic texture, pancreatic duct diameter, gland texture and surgical technique, however and is not significantly influenced by the post-operative administration of somatostatin. Oour results do not support the routinely use administration of somatostatin for the prevention of POPF after PD.

THE ROUTINE ADMINISTRATION OF SOMATOSTATIN AFTER PANCREATODUODENECTOMY: IS IT STILL JUSTIFIED? A CASE- MATCHED COMPARISON BASED ON FISTULA RISK SCORE, ASA SCORE AND SURGICAL TECHNIQUE

Palmeri M;Furbetta N;Gianardi D;Guadagni S;Di Franco G;Bianchini M;D'Isidoro C;Caprili G;Di Candio G;Mosca F;Morelli L
2019

Abstract

Background Pancreatoduodenectomy (PD) is one of the mosta technically demanding operationschallenging procedure. In recent decades, mortality has reduced in high-volume centers thanks to technical evolution and perioperative management improvements . Post-operative pancreatic fistula (POPF) still remainsis the main cause of morbidity, with a reported ranging incidence from 2% to 42.5% reported in literature. Most of POPF are successfully treated resolve with conservative management,, and only a small percentage requires percutaneous drainage or surgical operation. The routine use administration of somatostatin in POPF prevention of POPF is controversial and several works have shown no beneficial effects in this setting. The aim of this study is to compare the incidence of fistula in patients who underwent PD with the same pancreatojejunostomy technique, with and without the postoperative use of somatostatin. Methods Between October 2008 and October 2018, A total of 493 pancreatic resections were performed at the our General Surgery Unit, University of Pisa between October 2008 and October 2018.; Among these, 259 were PD, 152 of which 152 were carried out with a personal, modified invaginatedion pancreatojejunostomy technique (mPJ), introduced on November 2010. Somatostatin was routinely administered after PD with mPJ technique (mPJ-PD) between November 2010 and December 2016, while from January 2017 to October 2018, 52 consecutive mPJ-PD without somatostatin (WS) were performed. The WS-group was retrospectively compared with a control (C) group of mPJ in whichwith a postoperative routine administration of somatostatin was routinely used. The two groups were matched using a one-to-one case-control methoddesign, based onaccording to Fistula Risk Score (FRS) and American Society of Anesthesiologists’ (ASA) score. The post operative outcomes of the two groups were compared, with a particular attention to POPF. Patients data were retrieved from the Institutional prospectively collected dedicated database. Results The study sample consists incounts 104 patients (52 WS-group versus 52 C-for each group). In both groups the FRS was graded as following: FRS=0, 3.8%; FRS=1-2, 19.2%; FRS=3-6, 61.5%; FRS=7-10, 15.4%. No difference was found in term of operative time (430.38  79.18 min in C-group versus 413.17  72.28 min in WS-group, p=0.8) and length of hospital stay (18.6 days in C-group vs 19.1 days in WS-group, p=0.7). In the WS-group, POPF occurred was registered in 12 patients: 9 were biochemical leaks (BL) and 3 were Grade B fistulas, whereas in the C-group 15 patients developed POPF (11 BL, 3 Grade B and 1 Grade C), without any significant difference between the two groups (p=0.7). No difference was documented for 30-days mortality (2 cases in WS-group versus 3 cases in BC-group; p=0.6). Conclusion Multiple factors are involved in tThe development of POPF after PD, such as is due to multiple factors including pancreatic texture, pancreatic duct diameter, gland texture and surgical technique, however and is not significantly influenced by the post-operative administration of somatostatin. Oour results do not support the routinely use administration of somatostatin for the prevention of POPF after PD.
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11568/986933
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