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Risk factors for postoperative pancreatic fistula in the Era of pasireotide

Published:February 18, 2022DOI:https://doi.org/10.1016/j.amjsurg.2022.02.050

      Highlights

      • Partial courses of pasireotide do not increase risk of pancreatic fistula.
      • Single preoperative dosing of pasireotide may be appropriate in low-risk patients.
      • Smoking is associated with pancreatic fistula in patients receiving pasireotide.
      • Firm gland texture may be prognostic in patients taking perioperative pasireotide.

      Abstract

      Introduction

      Postoperative pancreatic fistulas (POPFs) remain common; POPFs frequently require intervention, termed clinically-relevant POPFs (crPOPFs). Pasireotide is increasingly used to prevent POPF, however, risk factors for POPF in this population remain unexplored.

      Methods

      Patients undergoing pancreatectomy with perioperative pasireotide from 2013 to 2020 were identified from our institutional National Surgical Quality Improvement Project database. Logistic regression was utilized to identify risk factors associated with POPF.

      Results

      One-hundred patients were identified; 26 (26%) underwent distal pancreatectomy with the remainder undergoing pancreaticoduodenectomy. Thirty (30%) experienced POPF, with 21 crPOPFs. Only current smoking was significantly associated with crPOPF (OR 3.79, p = 0.04). Of 30 patients with a firm gland, none experienced crPOPF. Twenty-five received a partial course of pasireotide; 7/25 (28%) crPOPFs occurred versus 14/75 (19%) in patients receiving a full course (p = 0.38).

      Conclusion

      Shortened courses of pasireotide do not increase crPOPF risk; selective discontinuation may be suitable in low-risk patients. Smoking cessation should be encouraged.

      Keywords

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