Is the routine use of somatostatin after pancreatoduodenectomy justified? A case-matched comparison according to fistula risk score, ASA and surgical technique

Background The routine administration of somatostatin in post-operative pancreatic fistula (POPF) prevention is controversial and several works have shown no beneficial effects. The aim of this study is to compare the incidence of fistula in patients underwent PD with the same pancreatojejunostomy technique, with and without the postoperative use of somatostatin. Methods Between October 2008 and October 2018, 259 PD were performed at our unit; 152 of which were carried out with a personal, modified invaginated pancreatojejunostomy technique (mPJ), introduced from 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 with a postoperative routine administration of somatostatin. The two groups were matched using a one-to-one case-control method, based on Fistula Risk Score (FRS) and ASA score. The postoperative outcomes of the two groups were compared, with particular attention to POPF. Results The study sample counts 104 patients (52 for each group). No difference was found in operative time (430.38  79.18 min in C-group vs 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 WS-group, POPF occurred in 12 patients: 9 biochemical leaks (BL) and 3 Grade B fistulas, whereas in C-group 15 patients developed POPF (11 BL, 3 Grade B and 1 Grade C), without any significant difference (p=0.7). No difference was documented for 30-days mortality (2 cases in WS-group vs 3 cases in C-group; p=0.6). Conclusion Multiple factors are involved in the development of POPF after PD(pancreatic duct diameter, gland texture and surgical technique), however our results do not support the routine administration of somatostatin for the prevention of POPF after PD.