Somatostatin Analogues for the Prevention of Pancreatic Fistula after Open Pancreatoduodenectomy: A Nationwide Analysis

Purpose: Somatostatin analogues (SA) are varyingly used to try prevent development of a pancreatic postoperative fistula (POPF) after pancreatoduodenectomy. Some centers do not use SA, some it only in high-risk patients, and others all patients. The aim this study was evaluate the effect different protocols for SA on incidence POPF pancreatoduodenectomy Netherlands. Method: Dutch Pancreatic Cancer Audit (DPCA) is national, mandatory audit that registers patients Consecutive undergoing elective open indications were included from DPCA (2014-2017). Patients divided into six groups depending protocol: no octreotide, lanreotide, pasireotide, octreotide high risk lanreotide Primary endpoint (grade B C). updated alternative Fistula Risk Score (uaFRS) analyze occurrence clinically relevant across various scenarios (low-intermediate (<20%) (≥20%)). Results: Overall, 1992 with rate 13.1%. occurred less often when administered (9.4%) or if protocol (10.0%) compared other (varying 12.7-19.1%, p=0.001). Sub-analysis 577 (56.7%) uaFRS showed significantly lower treated 18.9%-27.4%) (p=<0.001). In 440 (43.3%) low-intermediate did differ between protocols. Multivariate regression analysis, controlling male sex, BMI, soft tissue, duct smaller than 3mm, ASA score III/IV, neuroendocrine tumor pathology, demonstrated be associated low OR (OR 0.387, 95% CI 0.180-0.834) use. Conclusion: This nationwide retrospective suggests beneficial reducing POPF. However, perioperative mortality unaffected. Since appear may reserved at