Comment on the article by Droeser et al.: 'Octreotide prophylaxis is not beneficial for biochemical activity and clinical severity of postoperative pancreatic fistula after pancreatic surgery'.

domized trials (2,245 patients) showed a significant reduction in overall postoperative complications by 31% and a reduced fistula rate in the octreotide group. This systematic review consequently recommended preventive octreotide application for routine use in patients undergoing pancreatic resections [9] . On the other hand, Gans et al. [10] showed in their meta-analysis published in the British Journal of Surgery in 2012 that therapeutically administered octreotide in patients with existing fistula after pancreatic resections did not result in lower fistula rates. These important pieces of evidence were not discussed by the authors, which is confusing. In table 2 of the presented article, the octreotide group had longer operations (p < 0.002), more blood loss (p < 0.049), higher mortality (18 vs. 7%), more fascial dehiscence (14 vs. 4 %), more abscess/perforations (23 vs. 9%) and more postoperative bleeding (23 vs. 4%) compared with controls. Therefore, in the presented study the controls are not at all comparable with the octreotide group. Dear Editor, I have read with great interest the article ‘Octreotide prophylaxis is not beneficial for biochemical activity and clinical severity of postoperative pancreatic fistula after pancreatic surgery’ by Droeser et al. [1] . In 1996, the editor of The Lancet described surgical research as a comic opera [2] , and I think this article belongs to the comic opera category. The authors retrospectively analyzed 78 patients with a pancreatic fistula after pancreatic resection. Twenty-two of them received octreotide, and 56 served as controls without octreotide application. In the multiple existing randomized controlled trials and systematic reviews investigating the role of octreotide in pancreatic surgery mentioned by the authors [3– 8] , octreotide was given prophylactically, i.e. before starting surgery. In the presented study, the authors administered octreotide after surgery, i.e. therapeutically. Therefore, the results of the presented study cannot be compared with the mentioned randomized controlled trials. Moreover, a current Cochrane review including 19 ranPublished online: September 14, 2013