Somatostatin analogues for the prevention of pancreatic fistula after open pancreatoduodenectomy: A nationwide analysis

B.T. Bootsma; V.D. Plat; T. van de Brug; D.E. Huisman; M. Botti; P.B. van den Boezem; B.A. Bonsing; K. Bosscha; C.H.C. Dejong; B. Groot-Koerkamp; J. Hagendoorn; E. van der Harst; I.H. de Hingh; V.E. de Meijer; M.D. Luyer; V.B. Nieuwenhuijs; B.K. Pranger; H.C. van Santvoort; J.H. Wijsman; B.M. Zonderhuis; G. Kazemier; M.G. Besselink; F. Daams; Dutch Pancreatic Canc Grp

doi:10.1016/j.pan.2022.03.006

Somatostatin analogues for the prevention of pancreatic fistula after open pancreatoduodenectomy: A nationwide analysis

B.T. Bootsma^*, V.D. Plat, T. van de Brug, D.E. Huisman, M. Botti, P.B. van den Boezem, B.A. Bonsing, K. Bosscha, C.H.C. Dejong, B. Groot-Koerkamp, J. Hagendoorn, E. van der Harst, I.H. de Hingh, V.E. de Meijer, M.D. Luyer, V.B. Nieuwenhuijs, B.K. Pranger, H.C. van Santvoort, J.H. Wijsman, B.M. ZonderhuisG. Kazemier, M.G. Besselink, F. Daams, Dutch Pancreatic Canc Grp

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background: Somatostatin analogues (SA) are currently used to prevent postoperative pancreatic fistula (POPF) development. However, its use is controversial. This study investigated the effect of different SA protocols on the incidence of POPF after pancreatoduodenectomy in a nationwide population.Methods: All patients undergoing elective open pancreatoduodenectomy were included from the Dutch Pancreatic Cancer Audit (2014-2017). Patients were divided into six groups: no SA, octreotide, lanreotide, pasireotide, octreotide only in high-risk (HR) patients and lanreotide only in HR patients. Primary endpoint was POPF grade B/C. The updated alternative Fistula Risk Score was used to compare POPF rates across various risk scenarios.Results: 1992 patients were included. Overall POPF rate was 13.1%. Lanreotide (10.0%), octreotide-HR (9.4%) and no protocol (12.7%) POPF rates were lower compared to the other protocols (varying from 15.1 to 19.1%, p = 0.001) in crude analysis. Sub-analysis in patients with HR of POPF showed a significantly lower rate of POPF when treated with lanreotide (10.0%) compared to no protocol, octreotide and pasireotide protocol (21.6-26.9%, p = 0.006). Octreotide-HR and lanreotide-HR protocol POPF rates were comparable to lanreotide protocol, however not significantly different from the other protocols. Multi-variable regression analysis demonstrated lanreotide protocol to be positively associated with a low odds-ratio (OR) for POPF (OR 0.387, 95% CI 0.180-0.834, p = 0.015). In-hospital mortality rates were not affected.Conclusion: Use of lanreotide in all patients undergoing pancreatoduodenectomy has a potential protective effect on POPF development. Protocols for HR patients only might be favorable too. However, future studies are warranted to confirm these findings. (C) 2022 The Authors. Published by Elsevier B.V. on behalf of IAP and EPC.

Original language	English
Pages (from-to)	421-426
Number of pages	6
Journal	Pancreatology
Volume	22
Issue number	3
DOIs	https://doi.org/10.1016/j.pan.2022.03.006
Publication status	Published - 1 Apr 2022

Keywords

Somatostatin analogues
Postoperative Pancreatic Fistula
Pancreatoduodenectomy
Lanreotide
Pasireotide
Octreotide
INTERNATIONAL STUDY-GROUP
PROPHYLACTIC OCTREOTIDE
SURGERY
EFFICACY
PHARMACOKINETICS
COMPLICATIONS
DEFINITION
PASIREOTIDE
RESECTIONS
CANCER

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Bootsma, B. T., Plat, V. D., van de Brug, T., Huisman, D. E., Botti, M., van den Boezem, P. B., Bonsing, B. A., Bosscha, K., Dejong, C. H. C., Groot-Koerkamp, B., Hagendoorn, J., van der Harst, E., de Hingh, I. H., de Meijer, V. E., Luyer, M. D., Nieuwenhuijs, V. B., Pranger, B. K., van Santvoort, H. C., Wijsman, J. H., ... Dutch Pancreatic Canc Grp (2022). Somatostatin analogues for the prevention of pancreatic fistula after open pancreatoduodenectomy: A nationwide analysis. Pancreatology, 22(3), 421-426. https://doi.org/10.1016/j.pan.2022.03.006

@article{ba408a698f304e48a64e81e67df1bdc4,

title = "Somatostatin analogues for the prevention of pancreatic fistula after open pancreatoduodenectomy: A nationwide analysis",

abstract = "Background: Somatostatin analogues (SA) are currently used to prevent postoperative pancreatic fistula (POPF) development. However, its use is controversial. This study investigated the effect of different SA protocols on the incidence of POPF after pancreatoduodenectomy in a nationwide population.Methods: All patients undergoing elective open pancreatoduodenectomy were included from the Dutch Pancreatic Cancer Audit (2014-2017). Patients were divided into six groups: no SA, octreotide, lanreotide, pasireotide, octreotide only in high-risk (HR) patients and lanreotide only in HR patients. Primary endpoint was POPF grade B/C. The updated alternative Fistula Risk Score was used to compare POPF rates across various risk scenarios.Results: 1992 patients were included. Overall POPF rate was 13.1%. Lanreotide (10.0%), octreotide-HR (9.4%) and no protocol (12.7%) POPF rates were lower compared to the other protocols (varying from 15.1 to 19.1%, p = 0.001) in crude analysis. Sub-analysis in patients with HR of POPF showed a significantly lower rate of POPF when treated with lanreotide (10.0%) compared to no protocol, octreotide and pasireotide protocol (21.6-26.9%, p = 0.006). Octreotide-HR and lanreotide-HR protocol POPF rates were comparable to lanreotide protocol, however not significantly different from the other protocols. Multi-variable regression analysis demonstrated lanreotide protocol to be positively associated with a low odds-ratio (OR) for POPF (OR 0.387, 95% CI 0.180-0.834, p = 0.015). In-hospital mortality rates were not affected.Conclusion: Use of lanreotide in all patients undergoing pancreatoduodenectomy has a potential protective effect on POPF development. Protocols for HR patients only might be favorable too. However, future studies are warranted to confirm these findings. (C) 2022 The Authors. Published by Elsevier B.V. on behalf of IAP and EPC.",

keywords = "Somatostatin analogues, Postoperative Pancreatic Fistula, Pancreatoduodenectomy, Lanreotide, Pasireotide, Octreotide, INTERNATIONAL STUDY-GROUP, PROPHYLACTIC OCTREOTIDE, SURGERY, EFFICACY, PHARMACOKINETICS, COMPLICATIONS, DEFINITION, PASIREOTIDE, RESECTIONS, CANCER",

author = "B.T. Bootsma and V.D. Plat and {van de Brug}, T. and D.E. Huisman and M. Botti and {van den Boezem}, P.B. and B.A. Bonsing and K. Bosscha and C.H.C. Dejong and B. Groot-Koerkamp and J. Hagendoorn and {van der Harst}, E. and {de Hingh}, I.H. and {de Meijer}, V.E. and M.D. Luyer and V.B. Nieuwenhuijs and B.K. Pranger and {van Santvoort}, H.C. and J.H. Wijsman and B.M. Zonderhuis and G. Kazemier and M.G. Besselink and F. Daams and {Dutch Pancreatic Canc Grp}",

note = "Funding Information: Ipsen provided financial support for the conduct of this study. Ipsen was not involved in the study design, collection, analysis or interpretation of data. The content is solely the responsibility of the authors. Publisher Copyright: {\textcopyright} 2022 The Authors",

year = "2022",

month = apr,

day = "1",

doi = "10.1016/j.pan.2022.03.006",

language = "English",

volume = "22",

pages = "421--426",

journal = "Pancreatology",

issn = "1424-3903",

publisher = "Elsevier",

number = "3",

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Bootsma, BT, Plat, VD, van de Brug, T, Huisman, DE, Botti, M, van den Boezem, PB, Bonsing, BA, Bosscha, K, Dejong, CHC, Groot-Koerkamp, B, Hagendoorn, J, van der Harst, E, de Hingh, IH, de Meijer, VE, Luyer, MD, Nieuwenhuijs, VB, Pranger, BK, van Santvoort, HC, Wijsman, JH, Zonderhuis, BM, Kazemier, G, Besselink, MG, Daams, F & Dutch Pancreatic Canc Grp 2022, 'Somatostatin analogues for the prevention of pancreatic fistula after open pancreatoduodenectomy: A nationwide analysis', Pancreatology, vol. 22, no. 3, pp. 421-426. https://doi.org/10.1016/j.pan.2022.03.006

TY - JOUR

T1 - Somatostatin analogues for the prevention of pancreatic fistula after open pancreatoduodenectomy: A nationwide analysis

AU - Bootsma, B.T.

AU - Plat, V.D.

AU - van de Brug, T.

AU - Huisman, D.E.

AU - Botti, M.

AU - van den Boezem, P.B.

AU - Bonsing, B.A.

AU - Bosscha, K.

AU - Dejong, C.H.C.

AU - Groot-Koerkamp, B.

AU - Hagendoorn, J.

AU - van der Harst, E.

AU - de Hingh, I.H.

AU - de Meijer, V.E.

AU - Luyer, M.D.

AU - Nieuwenhuijs, V.B.

AU - Pranger, B.K.

AU - van Santvoort, H.C.

AU - Wijsman, J.H.

AU - Zonderhuis, B.M.

AU - Kazemier, G.

AU - Besselink, M.G.

AU - Daams, F.

AU - Dutch Pancreatic Canc Grp

N1 - Funding Information: Ipsen provided financial support for the conduct of this study. Ipsen was not involved in the study design, collection, analysis or interpretation of data. The content is solely the responsibility of the authors. Publisher Copyright: © 2022 The Authors

PY - 2022/4/1

Y1 - 2022/4/1

N2 - Background: Somatostatin analogues (SA) are currently used to prevent postoperative pancreatic fistula (POPF) development. However, its use is controversial. This study investigated the effect of different SA protocols on the incidence of POPF after pancreatoduodenectomy in a nationwide population.Methods: All patients undergoing elective open pancreatoduodenectomy were included from the Dutch Pancreatic Cancer Audit (2014-2017). Patients were divided into six groups: no SA, octreotide, lanreotide, pasireotide, octreotide only in high-risk (HR) patients and lanreotide only in HR patients. Primary endpoint was POPF grade B/C. The updated alternative Fistula Risk Score was used to compare POPF rates across various risk scenarios.Results: 1992 patients were included. Overall POPF rate was 13.1%. Lanreotide (10.0%), octreotide-HR (9.4%) and no protocol (12.7%) POPF rates were lower compared to the other protocols (varying from 15.1 to 19.1%, p = 0.001) in crude analysis. Sub-analysis in patients with HR of POPF showed a significantly lower rate of POPF when treated with lanreotide (10.0%) compared to no protocol, octreotide and pasireotide protocol (21.6-26.9%, p = 0.006). Octreotide-HR and lanreotide-HR protocol POPF rates were comparable to lanreotide protocol, however not significantly different from the other protocols. Multi-variable regression analysis demonstrated lanreotide protocol to be positively associated with a low odds-ratio (OR) for POPF (OR 0.387, 95% CI 0.180-0.834, p = 0.015). In-hospital mortality rates were not affected.Conclusion: Use of lanreotide in all patients undergoing pancreatoduodenectomy has a potential protective effect on POPF development. Protocols for HR patients only might be favorable too. However, future studies are warranted to confirm these findings. (C) 2022 The Authors. Published by Elsevier B.V. on behalf of IAP and EPC.

AB - Background: Somatostatin analogues (SA) are currently used to prevent postoperative pancreatic fistula (POPF) development. However, its use is controversial. This study investigated the effect of different SA protocols on the incidence of POPF after pancreatoduodenectomy in a nationwide population.Methods: All patients undergoing elective open pancreatoduodenectomy were included from the Dutch Pancreatic Cancer Audit (2014-2017). Patients were divided into six groups: no SA, octreotide, lanreotide, pasireotide, octreotide only in high-risk (HR) patients and lanreotide only in HR patients. Primary endpoint was POPF grade B/C. The updated alternative Fistula Risk Score was used to compare POPF rates across various risk scenarios.Results: 1992 patients were included. Overall POPF rate was 13.1%. Lanreotide (10.0%), octreotide-HR (9.4%) and no protocol (12.7%) POPF rates were lower compared to the other protocols (varying from 15.1 to 19.1%, p = 0.001) in crude analysis. Sub-analysis in patients with HR of POPF showed a significantly lower rate of POPF when treated with lanreotide (10.0%) compared to no protocol, octreotide and pasireotide protocol (21.6-26.9%, p = 0.006). Octreotide-HR and lanreotide-HR protocol POPF rates were comparable to lanreotide protocol, however not significantly different from the other protocols. Multi-variable regression analysis demonstrated lanreotide protocol to be positively associated with a low odds-ratio (OR) for POPF (OR 0.387, 95% CI 0.180-0.834, p = 0.015). In-hospital mortality rates were not affected.Conclusion: Use of lanreotide in all patients undergoing pancreatoduodenectomy has a potential protective effect on POPF development. Protocols for HR patients only might be favorable too. However, future studies are warranted to confirm these findings. (C) 2022 The Authors. Published by Elsevier B.V. on behalf of IAP and EPC.

KW - Somatostatin analogues

KW - Postoperative Pancreatic Fistula

KW - Pancreatoduodenectomy

KW - Lanreotide

KW - Pasireotide

KW - Octreotide

KW - INTERNATIONAL STUDY-GROUP

KW - PROPHYLACTIC OCTREOTIDE

KW - SURGERY

KW - EFFICACY

KW - PHARMACOKINETICS

KW - COMPLICATIONS

KW - DEFINITION

KW - PASIREOTIDE

KW - RESECTIONS

KW - CANCER

U2 - 10.1016/j.pan.2022.03.006

DO - 10.1016/j.pan.2022.03.006

M3 - Article

C2 - 35304104

SN - 1424-3903

VL - 22

SP - 421

EP - 426

JO - Pancreatology

JF - Pancreatology

IS - 3

ER -