Goodsell Kristin E, Chauhan Sardar Shahmir B, Pillarisetty Venu G, Sham Jonathan G
Department of Surgery, University of Washington, Seattle, WA, USA.
Surgical Outcomes Research Center, University of Washington, Seattle, WA, USA.
Ann Surg Oncol. 2025 Jun 27. doi: 10.1245/s10434-025-17660-8.
Postoperative pancreatic fistula (POPF) is the defining complication following pancreatectomy. The incidence of POPF after pancreatic resection remains high even at experienced centers, with associated patient morbidity, increased healthcare costs, and poorer oncologic outcomes. There is evidence that POPF is more frequent after distal pancreatectomy. On the basis of the premise that reduction in pancreatic exocrine secretion reduces the risk of fistula formation, somatostatin analogs (SSA) to prevent POPF and its sequelae have been studied for more than 30 years. However, evidence regarding their efficacy remains mixed. Early multicenter randomized control trials demonstrated a benefit of octreotide in reducing POPF, although subsequent single-center studies failed to confirm these results. Despite additional studies demonstrating a significant reduction in POPF with the use of newer SSAs including pasireotide and lanreotide, surgical practices in the use of somatostatin analogs in preventing POPF are highly variable. Herein, we review three decades of available data on SSA for POPF prophylaxis and highlight the need for pragmatic, focused, and data-driven design for future trials with modern agents.
术后胰瘘（POPF）是胰腺切除术后的典型并发症。即使在经验丰富的中心，胰腺切除术后POPF的发生率仍然很高，这会导致患者发病、医疗费用增加以及肿瘤学预后较差。有证据表明，远端胰腺切除术后POPF更为常见。基于减少胰腺外分泌可降低瘘形成风险这一前提，人们研究生长抑素类似物（SSA）预防POPF及其后遗症已有30多年。然而，关于其疗效的证据仍然不一。早期多中心随机对照试验证明奥曲肽在降低POPF方面有获益，尽管随后的单中心研究未能证实这些结果。尽管有更多研究表明使用包括帕瑞肽和兰瑞肽在内的新型SSA可显著降低POPF，但生长抑素类似物在预防POPF中的手术应用差异很大。在此，我们回顾了三十年来关于SSA预防POPF的可用数据，并强调未来使用现代药物进行试验需要务实、有针对性且以数据为驱动的设计。
