University of Washington Department of Surgery, Seattle, WA, USA.
University of Washington Department of Surgery, Seattle, WA, USA; Fred Hutchinson Cancer Center, Seattle, WA, USA.
HPB (Oxford). 2024 Oct;26(10):1229-1236. doi: 10.1016/j.hpb.2024.06.002. Epub 2024 Jun 15.
Postoperative pancreatic fistulas lead to substantially increased morbidity, mortality, and healthcare costs after pancreatectomy. Studies have reported conflicting data on the role of prophylactic somatostatin analogs in the reduction of postoperative pancreatic fistula. Current practice patterns, surgeon beliefs, and barriers to using these drugs in the Americas is not known.
An online 26-question cross-sectional survey was distributed via email to the members of the Americas Hepato-Pancreato-Biliary Association in April 2023.
One hundred and two surgeons responded in spring 2023. 48.0% of respondents reported using prophylactic SSAs during their surgical training, however, only 29.4% do so in their current practice, most commonly when performing Whipple procedures. Octreotide was the most frequently used SSA (34.3%), followed by octreotide LAR (12.7%) and pasireotide (11.8%). Reasons for not prescribing included a lack of high-quality data (62.7%), perception of limited efficacy (34.3%) and high cost (30.4%).
These results highlight key areas for future study including understanding surgeon rationale for patient and drug selection. Variable practice patterns amongst surgeons also underscore the importance of generalizability in the design of future clinical trials in order to maximize impact.
胰腺手术后胰瘘会显著增加发病率、死亡率和医疗保健成本。研究报告显示，预防性生长抑素类似物在减少术后胰瘘方面的作用存在相互矛盾的数据。目前尚不清楚美洲地区的实践模式、外科医生的信念以及使用这些药物的障碍。
2023 年 4 月，通过电子邮件向美洲肝胆胰协会成员分发了一份包含 26 个问题的在线横断面调查。
2023 年春季，有 102 名外科医生做出了回应。48.0%的受访者报告在手术培训期间使用预防性 SSAs，但目前只有 29.4%的受访者在其当前实践中使用，最常见于胰十二指肠切除术。奥曲肽是最常使用的 SSA（34.3%），其次是奥曲肽 LAR（12.7%）和帕瑞肽（11.8%）。不处方的原因包括缺乏高质量数据（62.7%）、认为疗效有限（34.3%）和成本高（30.4%）。
这些结果突出了未来研究的关键领域，包括了解外科医生在患者和药物选择方面的基本原理。外科医生的实践模式存在差异，这也强调了未来临床试验设计的普遍性的重要性，以便最大限度地发挥影响。
