nach oben

European Surgery

Erschienen in:

06.10.2022 | original article

Perioperative management of pancreatic excretory function in the context of pancreatic head resections in PDAC patients

Is the choice of secretion inhibition showing an effect on the rate of clinically relevant fistulas (CR-POPF)?

verfasst von: Siegfried Sauseng, MD MBA FEBS, Arvin Imamovic, Josip Kresic, Thomas Niernberger, Hans Rabl

Erschienen in: European Surgery | Ausgabe 6/2022

Einloggen, um Zugang zu erhalten

Summary

Introduction

Postoperative pancreatic fistulas (POPF) are possible origins of dangerous and life-threatening complications after pancreatic head resections. In 2020, a review with over 52,000 patients showed that patients without secretion inhibition (SI) show a higher tendency to develop a POPF. However, there is still no consensus regarding the use of secretion inhibition or in which way it should be administered. The aim of our study is to show whether SI with somatostatin is superior to inhibition with a somatostatin analogue (SA).

Methods

This retrospective data analysis was retrieved from an existing databank. Between 3/2015 and 12/2018, a total of 66 PDAC patients underwent pancreatic head resection. In this group, somatostatin was used as a perioperative secretion inhibitor. The comparison group (n = 91) operated from 1/2010 to 12/2014 received an SA for inhibition. These groups were compared regarding the occurrence of clinically relevant (CR)-POPF.

Results

The frequency rates for biochemical leakage, type B, and type C fistulas in the SA group were 17.58% (n = 16), 30.76% (n = 28), and 9.89% (n = 9), respectively. The somatostatin group showed the following frequencies: 24.2% (n = 16) for biochemical leakage, 16.7% (n = 11) for type B, and 6.1% (n = 4) for type C fistulas. The overall occurrence of CR-POPF was significantly reduced in the somatostatin group (p = 0.0069).

Conclusion

The perioperative use of somatostatin is superior to the use of a somatostatin analogue for POPF prevention in the context of oncological pancreatic head resections.

Vorheriger Artikel Impact of the COVID-19 pandemic on the training of general surgery residents

Nächster Artikel Prognostic significance of comorbidities in patients with diffuse peritonitis

Wang X, Li X, Wei X, Jiang H, Lan C, et al. PD-L1 is a direct target of cancer-FOXP3 in pancreatic ductal adenocarcinoma (PDAC), and combined immunotherapy with antibodies against PD-L1 and CCL5 is effective in the treatment of PDAC. Signal Transduct Target Ther. 2020;5(1):38. https://doi.org/10.1038/s41392-020-0144-8.CrossRefPubMedPubMedCentral

Christiane J. Bruns. Synopsis—S3 guidelines pancreatic cancer. Chirurg. 2022;93:427–8.

Ouaïssi M, Giger U, Louis G, Sielezneff I, Farges O, et al. Ductal adenocarcinoma of the pancreatic head: a focus on current diagnostic and surgical concepts. World J Gastroenterol. 2012;18(24):3058–69. https://doi.org/10.3748/wjg.v18.i24.3058.CrossRefPubMedPubMedCentral

Karunakaran M, Barreto SG. Surgery for pancreatic cancer: current controversies and challenges. Future Oncol. 2021;17(36):5135–62. https://doi.org/10.2217/fon-2021-0533.CrossRefPubMed

Arjunan R, Karthik SDS, Chowdappa R, Althaf S, Srinivas C. Contemporary surgical, oncological, and survival outcomes of pancreaticoduodenectomy for periampullary tumours: a 5-year experience from tertiary cancer center. J Surg Oncol. 2021;12(3):603–10. https://doi.org/10.1007/s13193-021-01385-7.CrossRef

Bonaroti JW, Zenati MS, Al-Abbas AI, Rieser CJ, et al. Impact of postoperative pancreatic fistula on long-term oncologic outcomes after pancreatic resection. HPB. 2021;23(8):1269–76. https://doi.org/10.1016/j.hpb.2020.12.010.CrossRefPubMed

Dhayat SA, Tamim ANJ, Jacob M, Ebeling G, Kerschke L, Kabar I, Senninger N. Postoperative pancreatic fistula affects recurrence-free survival of pancreatic cancer patients. PLoS One. 2021;16(6):e0252727. https://doi.org/10.1371/journal.pone.0252727.CrossRefPubMedPubMedCentral

Søreide K, Healey AJ, Mole DJ, Parks RW. Pre-, peri- and post-operative factors for the development of pancreatic fistula after pancreatic surgery. HPB. 2019;21(12):1621–31. https://doi.org/10.1016/j.hpb.2019.06.004.CrossRefPubMed

Kamarajah SK, Bundred JR, Lin A, Halle-Smith J, Pande R, Sutcliffe R, Harrison EM, Roberts KJ, PARANOIA Study Group. Systematic review and meta-analysis of factors associated with post-operative pancreatic fistula following pancreatoduodenectomy. ANZ J Surg. 2021;91(5):810–21. https://doi.org/10.1111/ans.16408.CrossRefPubMed

10.

van Roessel S, Mackay TM, Tol JAMG, van Delden OM, van Lienden KP, et al. Impact of expanding indications on surgical and oncological outcome in 1434 consecutive pancreatoduodenectomies. HPB. 2019;21(7):865–75. https://doi.org/10.1016/j.hpb.2018.10.020.CrossRefPubMed

11.

Lichun Sun DHC. Somatostatin and its analogs. Curr Drug Targets. 2016;17(5):529–37. https://doi.org/10.2174/1389450116666141205163548.CrossRefPubMed

12.

Patel YC. Somatostatin and its receptor family. Front Neuroendocrinol. 1999;20(3):157–98. https://doi.org/10.1006/frne.1999.0183.CrossRefPubMed

13.

Reisine T. Somatostatin receptors. Am J Physiol. 1995;269(6 Pt 1):G813–G20. https://doi.org/10.1152/ajpgi.1995.269.6.G813.CrossRefPubMed

14.

Harris AG. Somatostatin and somatostatin analogues: pharmacokinetics and pharmacodynamic effects. Gut. 1994;35(3 Suppl):S1–S4. https://doi.org/10.1136/gut.35.3_suppl.s1.CrossRefPubMedPubMedCentral

15.

Uhlén M, et al. Tissue-based map of the human proteome. Science. 2015; https://doi.org/10.1126/science.1260419.CrossRefPubMed

16.

Leandros E, Antonakis PT, Albanopoulos K, Dervenis C, Konstadoulakis MM. Somatostatin versus octreotide in the treatment of patients with gastrointestinal and pancreatic fistulas. Can J Gastroenterol. 2004;18(5):303–6. https://doi.org/10.1155/2004/901570.CrossRefPubMed

17.

Popp FC, Bruns CJ. Range of variation of pancreaticojejunostomy in pancreatic head resection. Chirurg. 2017;88(1):3–10. https://doi.org/10.1007/s00104-016-0327-6.CrossRefPubMed

18.

Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M, International Study Group on Pancreatic Fistula Definition. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138:8–13.CrossRefPubMed

19.

Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, Allen P, Andersson R, Asbun HJ, Besselink MG, Conlon K, Del Chiaro M, Falconi M, Fernandez-Cruz L, Fernandez-Del Castillo C, Fingerhut A, Friess H, Gouma DJ, Hackert T, Izbicki J, Lillemoe KD, Neoptolemos JP, Olah A, Schulick R, Shrikhande SV, Takada T, Takaori K, Traverso W, Vollmer CR, Wolfgang CL, Yeo CJ, Salvia R, Buchler M, International Study Group on Pancreatic Surgery (ISGPS). The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After. Surgery. 2017;161:584–91.CrossRefPubMed

20.

Berberat PO, Friess H, Büchler MW. The role of octreotide in the prevention of complications following pancreatic resection. Digestion. 1999;60(suppl 2):15–22. https://doi.org/10.1159/000051476.CrossRefPubMed

21.

Katsourakis A, Zezos P, Noussios G, Kouklakis G, Chatzitheoklitos E, Simopoulos K, Pitiakoudis M. Does prophylactic administration of somatostatin decrease the rates of complications after pancreatic resection?: A clinical and electron microscopy study. Pancreas. 2013;42(1):37–41. https://doi.org/10.1097/MPA.0b013e3182557c24.CrossRefPubMed

22.

Callery MP, Pratt WB, Kent TS, et al. A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy. J Am Coll Surg. 2013;216(1):1–14. https://doi.org/10.1016/j.jamcollsurg.2012.09.002.CrossRefPubMed

23.

Chen J‑Y, Feng J, Wang X‑Q, Cai S‑W, Dong J‑HY-LC. Risk scoring system and predictor for clinically relevant pancreatic fistula after pancreaticoduodenectomy. World J Gastroenterol. 2015;21(19):5926–33. https://doi.org/10.3748/wjg.v21.i19.5926.CrossRefPubMedPubMedCentral

24.

Li Y, Zhou F, Zhu D‑M, Zhang Z‑X, Yang J, Yao J, Wei Y‑J, Xu Y‑L, Dei-Chun LJZ. Novel risk scoring system for prediction of pancreatic fistula after pancreaticoduodenectomy. World J Gastroenterol. 2019;25(21):2650–64. https://doi.org/10.3748/wjg.v25.i21.2650.CrossRefPubMedPubMedCentral

25.

Schuh F, Mihaljevic AL, Probst P, et al. A simple classification of pancreatic duct size and texture predicts postoperative pancreatic fistula: a classification of the international study group of pancreatic surgery (ISGPS). Ann Surg. 2021; https://doi.org/10.1097/SLA.0000000000004855.CrossRefPubMed

26.

Bertens KA, Crown A, Clanton J, et al. What is a better predictor of clinically relevant postoperative pancreatic fistula (CR-POPF) following pancreaticoduodenectomy (PD): postoperative day one drain amylase (POD1DA) or the fistula risk score (FRS)? HPB. 2017;19(1):75–81. https://doi.org/10.1016/j.hpb.2016.10.001.CrossRefPubMed

27.

Jiang L, Ning D, Xiaoping C. Prevention and treatment of pancreatic fistula after pancreatic body and tail resection: current status and future directions. Front Med. 2020;14(3):251–61. https://doi.org/10.1007/s11684-019-0727-3.CrossRefPubMed

28.

Liu P, Yang Q, Zhu L. The effects of different treatments on postoperative pancreatic fistula (POPF). J Investig Surg. 2020;33(5):491–2. https://doi.org/10.1080/08941939.2018.1529840.CrossRef

29.

Hank T, Sandini M, Ferrone CR, et al. Association between pancreatic fistula and long-term survival in the era of neoadjuvant chemotherapy. JAMA Surg. 2019;154(10):943–51. https://doi.org/10.1001/jamasurg.2019.2272.CrossRefPubMedPubMedCentral

30.

Birnbaum DJ, Bertucci F, Finetti P, Birnbaum D, Mamessier E. Head and body/tail pancreatic carcinomas are not the same tumors. Cancers. 2019;11(4):497. https://doi.org/10.3390/cancers11040497.CrossRefPubMedPubMedCentral

31.

Sülberg D, Chromik AM, Köster O, Uhl W. Prävention und Management von postoperativen Komplikationen in der Pankreaschirurgie. Prevention and Management of Postoperative Complications in Pancreatic Surgery. Zentralbl Chir. 2010;135(2):129–38. https://doi.org/10.1055/s-0030-1247317.CrossRefPubMed

32.

Mischinger HJ, Werkgartner G, Kornprat P, Marsoner K, Wagner D, Cerwenka H, Bacher H. Komplikationen in der Pankreaschirurgie. Wien Klin Mag. 2018;21:98–107. https://doi.org/10.1007/s00740-018-0226-1.CrossRef

Titel: Perioperative management of pancreatic excretory function in the context of pancreatic head resections in PDAC patients
Is the choice of secretion inhibition showing an effect on the rate of clinically relevant fistulas (CR-POPF)?
verfasst von: Siegfried Sauseng, MD MBA FEBS
Arvin Imamovic
Josip Kresic
Thomas Niernberger
Hans Rabl
Publikationsdatum: 06.10.2022
Verlag: Springer Vienna
Erschienen in: European Surgery / Ausgabe 6/2022
Print ISSN: 1682-8631
Elektronische ISSN: 1682-4016
DOI: https://doi.org/10.1007/s10353-022-00779-3

Springer Medizin Österreich

Summary

Introduction

Methods

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 6/2022

Surgery for positive vibes

Thoracoabdominal approach for traumatic diaphragmatic hernia in a hemodynamically unstable patient

Early detection of COVID-19 cholangiopathy using cholangioscopy—a case report of two critically ill patients

Prognostic significance of comorbidities in patients with diffuse peritonitis

Impact of the COVID-19 pandemic on the training of general surgery residents

Repeated hepatic resection for colorectal liver metastases: is this concept safe and feasible?