Background Pancreatoduodenectomy (PD) is one of the most technically demanding operations. In recent decades, technical evolution and perioperative management improvements have reduced mortality following PD in high-volume centers. Post-operative pancreatic fistula (POPF) still remains the main cause of morbidity, with a ranging incidence from 2% to 42.5% reported in literature. The routine use of somatostatin in 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 A total of 493 pancreatic resections were performed at the General Surgery Unit, University of Pisa between October 2008 and October 2018. Among these, 259 were PD of which 152 were carried out with a personal, modified invagination 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 which somatostatin was routinely used. The two groups were matched using a one-to-one case-control design, according 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 in 104 patients (52 WS-group versus 52 C-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 versus 19.1 days in ws-group, p=0.7). In the WS-group, POPF was registered in 12 patients: 9 were biochemical leak (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 B-group; 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.
IS THE ROUTINE USE OF SOMATOSTATIN AFTER PANCREATODUODENECTOMY JUSTIFIED? A CASE- MATCHED COMPARISON ACCORDING TO FISTULA RISK SCORE, ASA SCORE AND SURGICAL TECHNIQUE
Morelli L;Furbetta N;Guadagni S;Di Franco G;Palmeri M;Gianardi D;Bianchini M;D’isidoro C;Di Candio G;Mosca F
2019-01-01
Abstract
Background Pancreatoduodenectomy (PD) is one of the most technically demanding operations. In recent decades, technical evolution and perioperative management improvements have reduced mortality following PD in high-volume centers. Post-operative pancreatic fistula (POPF) still remains the main cause of morbidity, with a ranging incidence from 2% to 42.5% reported in literature. The routine use of somatostatin in 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 A total of 493 pancreatic resections were performed at the General Surgery Unit, University of Pisa between October 2008 and October 2018. Among these, 259 were PD of which 152 were carried out with a personal, modified invagination 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 which somatostatin was routinely used. The two groups were matched using a one-to-one case-control design, according 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 in 104 patients (52 WS-group versus 52 C-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 versus 19.1 days in ws-group, p=0.7). In the WS-group, POPF was registered in 12 patients: 9 were biochemical leak (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 B-group; 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.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
