A Cost Analysis of Somatostatin use in the Prevention of Pancreatic Fistula after Pancreatectomy

Background: Pancreas surgery has developed into a fairly safe procedure in terms of mortality, but is still hampered by considerable morbidity. Among the most frequent and dreaded complications are the development of a post-operative pancreatic fistula (POPF). The prediction and prevention of POPF remains an area of debate with several questions yet to be firmly addressed with solid answers. Methods: A systematic review of systematic reviews/meta-analyses and randomized trials in the English literature (PubMed/MEDLINE, Cochrane library, EMBASE) covering January 2005 to December 2015 on risk factors and preventive strategies for POPF. Results: A total of 49 systematic reviews and meta-analyses over the past decade discussed patient, surgeon, pancreatic disease and intraoperative related factors of POPF. Non-modifiable factors (age, BMI, comorbidity) and pathology (histotype, gland texture, duct size) that indicates surgery are associated with POPF risk. Consideration of anastomotic technique and use of somatostatin-analogs may slightly modify the risk of fistula. Sealant products appear to have no effect. Perioperative bleeding and transfusion enhance risk, but is modifiable by focus on technique and training. Drains may not prevent fistulae, but may help in early detection. Early drain-amylase may aid in detection. Predictive scores lack uniform validation, but may have a role in patient information if reliable pre-operative risk factors can be obtained. Conclusions: Development of POPF occurs through several demonstrated risk factors. Anastomotic technique and use of somatostatin-analogs may slightly decrease risk. Drains may aid in early detection of leaks, but do not prevent POPF.

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“…This drug is currently more costly than other somatostatin-analogs, for which cost-effectiveness have not been demonstrated. [ 114 ]…”

Section: Resultsmentioning

confidence: 99%

Risk factors and preventive strategies for post-operative pancreatic fistula after pancreatic surgery: a comprehensive review

Søreide

Labori

2016

Scandinavian Journal of Gastroenterology

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“…Furthermore, this drug is currently more costly than other somatostatin-analogues, for which cost-effectiveness have not been demonstrated. 63 In a small series, the use of triple drug therapy involving gabexate mesilate, octreotide and carbapenem antibiotics reduced the POPF rate. 64 Gabexate is an inhibitor of phospholipase A2 in the pancreatic protease activation cascade.…”

Section: Preventive Drugsmentioning

confidence: 98%

Pre-, peri- and post-operative factors for the development of pancreatic fistula after pancreatic surgery

Søreide

Healey

Mole

et al. 2019

HPB

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Background: The most hazardous complication to pancreatic surgery is the development of a postoperative pancreatic fistula (POPF). Appropriate understanding of the underlying pathophysiology, risk factors and perioperative mechanisms may allow for better management and use of preventive measures.Methods: Systematic literature search using the English PubMed literature up to April 2019, with emphasis on the past 5 years. Results: Several risk scores have been developed but none are perfect in predicting POPF risk. A conceptual framework of factors that contribute to the pathophysiology of pancreatic fistulae is still developing but incomplete. Recognized factors include those related to the patient, the pathology and the perioperative care. Interventions such as use of drains, stents and various drugs to mediate risk is still debated. Emerging data suggest that both the microbiome and the inflammation in the post-operative phase may play important roles in risk for POPF. Available risk scores allow for stratification of risk and mitigation strategies tailored to reduce this. However, accurate estimation of risk remains a challenge and mechanisms are only partially understood. Conclusions: The pathophysiology of POPF remains poorly understood. Current models only partially explain risks or associated mechanisms. Novel areas of investigation need to be explored for better prediction.

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“…Oral nutrition is restricted, followed by parenteral nutrition, aided with drugs like somatostatin and its analogues, reducing the exocrine secretion of the organ. The first successful use of somatostatin in the prevention of pancreatic fistulas dates back to the year 1979 [1,6,7].…”

Section: Discussionmentioning

confidence: 99%

“…The latest research on somatostatin therapy confirms its positive impact on pancreatic fistula treatment and prevention after pancreatic surgery. At the same time, a similar effect with the analogue of somatostatin -octreotide -is being questioned in terms of successful fistula treatment [1]. Parenteral nutrition is also an essential part of proper initial pancreatic fistula therapy, although more detailed information on the subject is beyond the scope of this article.…”

Section: Discussionmentioning

confidence: 99%

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Successful postoperative pancreatic fistula treatment with the use of somatostatin infusion after duodenal gastrointestinal stromal tumor resection

et al. 2019

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Introduction According to the International Study Group on Pancreatic Fistula, a postoperative pancreatic fistula is defined as every case of fluid leak on the third (or later) postoperative day, in which the level of amylase in the collected fluid is at least three times higher than the serum amylase level. Depending on the stage and the designated management, pancreatic fistulas are divided into the following three categories: A (mild), B, and C (severe). Regardless of favorable conditions, exocrine pancreatic secretion is the key factor in fistula formation. The decrease in pancreatic secretion caused by somatostatin and its analogues combined with parenteral nutrition is a well-established treatment method in pancreatic fistula management. Case outline The case of a 69-year-old patient who had undergone a resection of a duodenal gastrointestinal stromal tumor located directly above the major duodenal papilla is presented. Excessive drainage of amylase-rich fluid was observed in the postoperative period. Treatment comprised continuous infusion of somatostatin and parenteral nutrition. Fistula closure was accomplished on postoperative day 14, confirmed by a radical decrease in the volume of drainage and low amylase levels in the collected fluid. The patient remained in a good clinical state and was discharged from hospital on postoperative day 20. Conclusion This is an example of the early diagnosis of a postoperative pancreatic fistula, treated conservatively with the use of somatostatin. Post-surgery clinical awareness of the importance of direct contact between the stromal tumor and pancreatic tissues, in connection with routine amylase level assessment, led to a quick diagnosis of pancreatic fistula and the therapy led to an uneventful outcome.

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A Cost Analysis of Somatostatin use in the Prevention of Pancreatic Fistula after Pancreatectomy

Abstract: Pancreatic fistulas significantly increase hospital costs, and somatostatin has been shown to decrease the rate of pancreatic fistula formation. Somatostatin has no significant effect on hospital costs.

Cited by 8 publications

References 51 publications

Risk factors and preventive strategies for post-operative pancreatic fistula after pancreatic surgery: a comprehensive review

Risk factors and preventive strategies for post-operative pancreatic fistula after pancreatic surgery: a comprehensive review

Pre-, peri- and post-operative factors for the development of pancreatic fistula after pancreatic surgery

Successful postoperative pancreatic fistula treatment with the use of somatostatin infusion after duodenal gastrointestinal stromal tumor resection

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