The Study On The Effect Of Somatostatin And Its Analogs On Pancreatic Fistula After Pancreatic Cancer Surgery

Objective: There are few studies on the effect of somatostatin application on pancreatic fistula after pancreatic cancer surgery,to analyze whether the use of somatostatin and its analogs can prevent the occurrence of postoperative pancreatic fistula.Methods: From January 2013 to December 2019,82 cases who underwent radical resection of pancreatic cancer in the department of hepatobiliary and pancreatic surgery of the Second affiliated hospital of Zhejiang University School of Medicine by the same surgeon were retrospective reviewed.Subgroup analysis of pancreaticoduodenectomy and distal pancreatic cancer radical resection was performed,and the patients were classificated as two groups depending on the status of postoperative pancreatic fistula.SPSS 17.0 software was used for statistical analysis.The Pearson c2 test was used to analyze the factors affecting the occurrence of POPF,and the possible risk factors were selected.The multivariate analysis of the possible risk factors was performed using binary or multiple Logistic regression to determine the independent risk factors affecting the occurrence of pancreatic fistula after surgery.The P value of <0.05 was considered statistically significant.The primary endpoint were pancreatic fistula(PF)and clinically relevant pancreatic fistula(CRPF),according to the definition of ISGPF,pancreatic fistula includes grade A,B,and C pancreatic fistula,and clinically relevantpancreatic fistula includes grade B and C pancreatic fistula;secondary endpoints were postoperative complications.Result: A total of 82 patients with pancreatic cancer were included who met the criteria,61 patients(74%)were treated with somatostatin or its analogues and 21patients(26%)without somatostatin after surgery.The incidence of pancreatic fistula in this study was 45.1%(37/82),of which clinically relevant pancreatic fistula was 18.3%(15/82).Subgroup analysis shows that the incidence of pancreatic fistula in patients treated with somatostatin or its analogues after pancreaticoduodenectomy was 32.4%(12/37),and the incidence of CRPF was 18.9%(7/37),the incidence of pancreatic fistula in patients treated without somatostatin or its analogue was 50%(2/4),and the incidence of CRPF was 25%(1/4);the incidence of pancreatic fistula in patients treated with somatostatin or its analogues after distal pancreatic cancer radical resection was66.7%(16/24),and the incidence of CRPF was 25%(6/24),the incidence of PF in patients treated without somatostatin or its analogue was 41.2%(7/17),and the incidence of CRPF was 5.8%(1/17).According to the results of univariate analysis,patients with and without pancreatic fistula after pancreaticoduodenectomy or distal pancreatectomy have no significant difference in the following factors: gender,combined diabetes,combined hypertension,body mass index(BMI),preoperative albumin,preoperative bilirubin,anastomosis method,operation time,intraoperative blood loss,with or without somatostatin or its analogues,somatostatin or its analog usage time(P> 0.05).There was statistically significant difference in age(?64y vs <64y,P =0.023)in patients with and without pancreatic fistula after distal pancreatic cancer radical resection,but there was no significant difference in patients after pancreaticoduodenectomy.Univariate analysis showed that the above factors had no correlation with clinically relevant postoperative pancreatic fistula(P> 0.05).Univariate analysis showed that postoperative grade ? or higher complications(P = 0.024)may affect the hospital stays of patients after distal pancreatic cancer radical resection.The average total hospitalization costs and drug costs were higher in the somatostatin group,but the difference was not statistically significant(P> 0.05).Conclusion: The incidence of pancreatic fistula after pancreatic cancer surgery can not be reduced with Somatostatin and its analogues,also the risk of complications such as postoperative bile leakage,delayed gastric emptying,and lung infections is not reduced,but upward trend can be seen for the cost of hospitalization and medication.