Department of Surgery, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico.
Department of Surgery, Barnes-Jewish Hospital and Washington University School of Medicine, Saint Louis, MO; Alvin J Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO.
J Am Coll Surg. 2018 Feb;226(2):147-154.e1. doi: 10.1016/j.jamcollsurg.2017.10.021. Epub 2017 Nov 11.
Pasireotide is a newer generation somatostatin analogue that led to a significant reduction in pancreatic fistula after pancreatectomy in a single-center randomized controlled trial. We sought to determine if pasireotide reduces the incidence of pancreatic fistula and other complications after pancreaticoduodenectomy at our high volume center.
All patients undergoing pancreaticoduodenectomy between April 2011 and January 2017 were prospectively followed, and their complications were graded using the Modified Accordion Grading System (MAGS) in our institutional complications database. For 18 months, 5 pancreatic surgeons used pasireotide routinely in patients undergoing pancreaticoduodenectomy. Patients receiving pasireotide were then propensity score-matched to patients who did not receive pasireotide, and their outcomes were compared.
There were 459 patients who underwent pancreaticoduodenectomy, and 127 patients (28%) received pasireotide. Patients who received pasireotide were significantly more likely to have dilated pancreatic ducts and have a drain left at the time of surgery. Patients who received pasireotide had no difference in pancreatic fistula, overall complications, 90-day readmission, or 90-day mortality. However, patients who received pasireotide had a significantly reduced rate of postoperative bleeding/anemia (8.7% vs 16.9%, p = 0.03). Among 112 propensity score-matched pairs, patients who received pasireotide did not have significantly different rates of pancreatic fistula, and the rates of severe (MAGS grades 3 to 6) pancreatic fistula were identical between the 2 groups (7.1% vs 7.1%, p = 1.00). Matched patients who received pasireotide had significantly decreased postoperative bleeding/anemia (9.8% vs 19.6%, p = 0.04).
Pasireotide did not reduce the incidence or severity of pancreatic fistulas after pancreaticoduodenectomy, but was associated with a decrease in postoperative bleeding/anemia. A multicenter randomized trial is needed to accurately define the role of pasireotide in the postoperative management of pancreaticoduodenectomy patients.
在一项单中心随机对照试验中，培高利特是一种新型生长抑素类似物，可显著降低胰腺切除术后胰瘘的发生率。我们旨在确定在我们的大容量中心，培高利特是否会降低胰十二指肠切除术后胰瘘和其他并发症的发生率。
所有 2011 年 4 月至 2017 年 1 月期间行胰十二指肠切除术的患者均前瞻性随访，并在我们的机构并发症数据库中使用改良 Accordion 分级系统（MAGS）对其并发症进行分级。在 18 个月的时间里，有 5 位胰腺外科医生常规在接受胰十二指肠切除术的患者中使用培高利特。然后，将接受培高利特治疗的患者与未接受培高利特治疗的患者进行倾向评分匹配，并比较其结局。
共有 459 例患者行胰十二指肠切除术，其中 127 例（28%）接受了培高利特治疗。接受培高利特治疗的患者胰管扩张和术中留置引流管的可能性明显更高。接受培高利特治疗的患者胰瘘、总体并发症、90 天再入院率或 90 天死亡率均无差异。然而，接受培高利特治疗的患者术后出血/贫血的发生率明显降低（8.7%比 16.9%，p=0.03）。在 112 对匹配的患者中，接受培高利特治疗的患者胰瘘发生率无显著差异，两组严重（MAGS 分级 3-6）胰瘘发生率相同（7.1%比 7.1%，p=1.00）。接受培高利特治疗的匹配患者术后出血/贫血发生率明显降低（9.8%比 19.6%，p=0.04）。
胰十二指肠切除术后，培高利特并未降低胰瘘的发生率或严重程度，但与术后出血/贫血减少相关。需要进行多中心随机试验，以准确确定培高利特在胰十二指肠切除术后患者管理中的作用。
