Pasireotide Does Not Prevent Postoperative Pancreatic Fistula: A Prospective Study

Elliott, Irmina A.; Dann, Amanda M.; Ghukasyan, Razmik; Damato, Lauren; Chung, Hyun-Kyung; Girgis, Mark D.; King, Jonathan C.; Reber, Howard A.; Hines, Oscar J.; Donahue, Timothy R.

doi:10.1016/j.jamcollsurg.2017.07.302

Cited by 5 publications

(16 citation statements)

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“…Elliott et al at the University of California Los Angeles reported 111 consecutive patients who received pasireotide undergoing PD or DP, compared to a historical cohort who did not receive the medication 7 . No differences were detected in the CR‐POPF rate (17.1% pasireotide vs 15.5% control, P = .715) or length of stay.…”

Section: Discussionmentioning

confidence: 99%

“…Since the original publication, a number of concerns regarding the applicability of the data at other centers have been raised, including low usage of surgical drains at MSKCC, the high rate of overall complications in the study, and high rate of POPF reported in the placebo group 5 . These promising results have failed to be replicated in several other single‐institution series 6‐8 which have not shown a reduction in CR‐POPF with pasireotide.…”

Section: Introductionmentioning

confidence: 96%

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Risk‐stratified analysis of pasireotide for patients undergoing pancreatectomy

Peng

Joyce

Brady

et al. 2020

Journal of Surgical Oncology

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Background and Objectives Pasireotide was shown in a randomized trial to decrease the rate of postoperative pancreatic fistula (POPF). However, retrospective series from other centers have failed to confirm these results. Methods Patients who underwent pancreatoduodenectomy or distal pancreatectomy between January 2014 and February 2019 were included. Patients treated after November 2016 routinely received pasireotide and were compared to a retrospective cohort. Multivariate analysis was performed for the outcome of clinically relevant POPF (CR‐POPF), with stratification by fistula risk score (FRS). Results Ninety‐nine of 300 patients received pasireotide. The distribution of high, intermediate, low, and negligible risk patients by FRS was comparable (P = .487). There were similar rates of CR‐POPF (19.2% pasireotide vs 14.9% control, P = .347) and percutaneous drainage (12.1% vs 10.0%, P = .567), with greater median number of drain days in the pasireotide group (6 vs 4 days, P < .001). Multivariate modeling for CR‐POPF showed no correlation with operation or pasireotide use. Adjustment with propensity weighted models for high (OR, 1.02, 95% CI, 0.45‐2.29) and intermediate (OR, 1.02, CI, 0.57‐1.81) risk groups showed no correlation of pasireotide with reduction in CR‐POPF. Conclusions Pasireotide administration after pancreatectomy was not associated with a decrease in CR‐POPF, even when patients were stratified by FRS.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 96%

Risk‐stratified analysis of pasireotide for patients undergoing pancreatectomy

Peng

Joyce

Brady

et al. 2020

Journal of Surgical Oncology

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“…Patient demographics and characteristics were evaluated for differences between groups. Age range from 3 studies 13-15 was converted to estimate SD (Table 1). 19 Three studies defined a dilated pancreatic duct with a diameter >4 mm at the site of transection, 12,13,16 whereas another study defined a dilated duct to be >3 mm.…”

Section: Methodsmentioning

confidence: 99%

“…19 Three studies defined a dilated pancreatic duct with a diameter >4 mm at the site of transection, 12,13,16 whereas another study defined a dilated duct to be >3 mm. 15 The cancer diagnosis was reported in multiple histologies across centers, so it was considered a binary event for this analysis. Pancreatic gland texture was consistently reported with subjective surgeon assessment.…”

Section: Methodsmentioning

confidence: 99%

“…However, published data from these centers did not produce similar results. 14-16 In light of these discrepancies, the primary aim was to perform an analysis of available prospective trials and determine if the prophylactic administration of pasireotide after pancreatectomy was associated with a decrease in the incidence of clinically significant POPF compared with control patients.…”

Section: Introductionmentioning

confidence: 99%

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Meta-Analysis on the Effect of Pasireotide for Prevention of Postoperative Pancreatic Fistula

Dalton

Johns

Rhodes

et al. 2020

The American Surgeon

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Background A randomized controlled trial of routine administration of pasireotide demonstrated decreased incidence of clinically significant postoperative pancreatic fistula (POPF). Recent studies have not replicated these results. A meta-analysis was performed to evaluate its efficacy in this setting. Methods Prospective trials utilizing pasireotide prophylactically after pancreatectomy were reviewed. The primary outcome was clinically significant POPF. Secondary outcomes included length of stay (LOS), readmission rates, and mortality. Study heterogeneity was assessed. Results Five studies totaling 1571 patients were identified. There was no difference in age, sex, or cancer rates. Pasireotide patients had smaller pancreatic ducts ( P < .001) and softer glands ( P = .04). For all pancreatectomies, there was no difference in POPF rates (odds ratio [OR] 0.84; 95% CI 0.60-1.16, P = .29). Patients undergoing distal pancreatectomy (OR 0.70; 95% CI 0.30-1.63, P = .41) had similar rates of POPF versus pancreaticoduodenectomy (PD) patients who experienced a lower incidence of POPF (OR 0.60; 95% CI 0.42-0.86, P = .006). Mortality rates and LOS were similar. Readmission rates were decreased with pasireotide (OR 0.61; 95% CI 0.44-0.85). Conclusions Routine administration of pasireotide did not decrease POPF rates for all pancreatectomies, but was associated with lower rates for PD, and decreased readmission rates. Further prospective, randomized studies are warranted.

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Chirurgie periampullärer Pankreaskarzinome

Hank

Klaiber

Sahora

et al. 2021

Chirurg

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ZusammenfassungPeriampulläre Neoplasien sind eine heterogene Gruppe verschiedener Tumorentitäten der periampullären Region, von denen das Pankreasadenokarzinom mit 60–70 % am häufigsten ist. Wie typisch für Pankreaskarzinome zeichnen sich periampulläre Pankreaskarzinome durch ein aggressives Wachstum und eine frühe systemische Progression aus. Aufgrund ihrer besonderen Lage in unmittelbarer Nähe zur Papilla Vateri treten Symptome in eher früherem Tumorstadium auf, sodass die Therapiemöglichkeiten und Prognose insgesamt günstiger sind als bei Pankreaskarzinomen anderer Lokalisation. Trotzdem unterscheiden sich die Therapieprinzipien bei periampullären Pankreaskarzinomen nicht wesentlich von den Standards bei Pankreaskarzinomen anderer Lokalisation. Ein potenziell kurativer Therapieansatz beim nichtmetastasierten periampullären Pankreaskarzinom ist multimodal und besteht aus der Durchführung einer partiellen Duodenopankreatektomie als radikale onkologische Resektion in Kombination mit einer systemischen, meist adjuvant verabreichten Chemotherapie. Bei Patienten mit günstigen prognostischen Faktoren kann hierdurch ein Langzeitüberleben erzielt werden. Zudem wurden mit der Weiterentwicklung der Chirurgie und Systemtherapie auch potenziell kurative Therapiekonzepte für fortgeschrittene, früher irresektable Tumoren etabliert, welche nun nach Durchführung einer neoadjuvanten Therapie oft einer Resektion zugeführt werden können. In diesem Beitrag werden die aktuellen chirurgischen Prinzipien der radikalen onkologischen Resektion periampullärer Pankreaskarzinome im Kontext der multimodalen Therapie dargestellt und ein Ausblick auf mögliche künftige Entwicklungen der Therapie gegeben.

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Pasireotide Does Not Prevent Postoperative Pancreatic Fistula: A Prospective Study

Cited by 5 publications

References 0 publications

Risk‐stratified analysis of pasireotide for patients undergoing pancreatectomy

Risk‐stratified analysis of pasireotide for patients undergoing pancreatectomy

Meta-Analysis on the Effect of Pasireotide for Prevention of Postoperative Pancreatic Fistula

Chirurgie periampullärer Pankreaskarzinome

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