Outcomes after pancreatectomy with routine pasireotide use Journal Article

Authors: Kunstman, J. W.; Goldman, D. A.; Gӧnen, M.; Balachandran, V. P.; D'Angelica, M. I.; Kingham, T. P.; Jarnagin, W. R.; Allen, P. J.
Article Title: Outcomes after pancreatectomy with routine pasireotide use
Abstract: Background: Morbidity after pancreatectomy is commonly due to leakage of exocrine secretions resulting in abscess or pancreatic fistula (PF). Previously, we authored a double-blind randomized controlled trial demonstrating that perioperative pasireotide administration lowers abscess or PF formation by >50%. Accordingly, we adopted pasireotide use as standard practice after pancreatectomy in October 2014 and hypothesized a similar PF/abscess rate reduction would be observed. Study Design: A prospectively maintained database was queried for all patients who underwent pancreatectomy between October 2014 and July 2017. Pasireotide was administered preoperatively and twice daily for 7 days postoperatively or until discharge. The primary end point was clinically relevant PF/abscess requiring procedural intervention, identical to the earlier trial outcomes. Logistic regression was used to compare outcomes with the placebo arm of the earlier randomized trial and to control known PF risk factors. Results: During the 34-month study period, 652 patients underwent pancreatectomy (211 distal pancreatectomy, 441 pancreaticoduodenectomy). Compared with the historical placebo group (n = 148), the observational group had an increased prevalence of higher American Society of Anesthesiologists scores (69% vs 54%; p < 0.001) and high-risk cases (small duct and soft gland, 47% vs 36%; p = 0.030). The primary end point occurred in 13.3% of patients receiving pasireotide vs 20.9% in the placebo arm of the earlier trial trial (odds ratio 0.58; 95% CI 0.37 to 0.92; p = 0.020). Biliary leakage was lower in those receiving pasireotide (0.6% vs 3.4%; p = 0.014), and other morbidity was unchanged. No subpopulation was identified more likely to benefit from pasireotide. Conclusions: At our center, adoption of pasireotide has allowed us to achieve a clinically significant abscess or pancreatic leak rate of 13.3%, approximating the effect observed in the randomized trial of pasireotide during routine surgical practice. © 2018 American College of Surgeons
Journal Title: Journal of the American College of Surgeons
Volume: 228
Issue: 2
ISSN: 1072-7515
Publisher: Elsevier Science, Inc.  
Date Published: 2019-02-01
Start Page: 161
End Page: 170.e2
Language: English
DOI: 10.1016/j.jamcollsurg.2018.10.018
PROVIDER: scopus
PUBMED: 30414453
Notes: Article -- Export Date: 1 February 2019 -- Source: Scopus
Altmetric Score
MSK Authors
  1. Mithat Gonen
    701 Gonen
  2. Peter Allen
    436 Allen
  3. William R Jarnagin
    583 Jarnagin
  4. T Peter Kingham
    281 Kingham
  5. Debra Alyssa Goldman
    92 Goldman