Outcomes after Pancreatectomy with Routine Pasireotide Use

Area of Science:

• Gastroenterology
• Surgical Oncology
• Clinical Pharmacology

Background:

• Pancreatectomy carries a risk of morbidity from exocrine leakage, leading to abscess or pancreatic fistula (PF).
• Previous research demonstrated that perioperative pasireotide significantly reduces PF/abscess formation.
• Pasireotide was implemented as standard care post-pancreatectomy in October 2014.

Purpose of the Study:

• To evaluate the effectiveness of pasireotide in reducing PF/abscess rates in routine clinical practice.
• To compare outcomes with historical data from a placebo group in a prior randomized controlled trial.
• To assess the impact of pasireotide on overall morbidity after pancreatectomy.

Main Methods:

• A prospectively maintained database was queried for patients undergoing pancreatectomy between October 2014 and July 2017.
• Pasireotide was administered preoperatively and for 7 days postoperatively or until discharge.
• Logistic regression analysis was used to compare outcomes with a historical placebo group, controlling for risk factors.

Main Results:

• The incidence of clinically relevant PF/abscess was 13.3% in the pasireotide group versus 20.9% in the historical placebo group (OR 0.58; P=0.020).
• Patients receiving pasireotide had a lower prevalence of biliary leakage (0.6% vs 3.4%; P=0.014).
• The observational group had a higher prevalence of ASA scores and high-risk surgical cases compared to the placebo group.

Conclusions:

• Routine adoption of pasireotide post-pancreatectomy achieved a clinically significant reduction in abscess or pancreatic leak rates.
• The observed rate of 13.3% approximates the effect seen in the randomized trial, validating its use in practice.
• No specific subpopulation was identified as more likely to benefit from pasireotide treatment.