Risk factors for postoperative pancreatic fistula in the Era of pasireotide

Introduction: Postoperative pancreatic fistulas (POPFs) remain common; POPFs frequently require intervention, termed clinically-relevant POPFs (crPOPFs). Pasireotide is increasingly used to prevent POPF, however, risk factors for POPF in this population remain unexplored. Methods: Patients undergoing pancreatectomy with perioperative pasireotide from 2013 to 2020 were identified from our institutional National Surgical Quality Improvement Project database. Logistic regression was utilized to identify risk factors associated with POPF. Results: One-hundred patients were identified; 26 (26%) underwent distal pancreatectomy with the remainder undergoing pancreaticoduodenectomy. Thirty (30%) experienced POPF, with 21 crPOPFs. Only current smoking was significantly associated with crPOPF (OR 3.79, p = 0.04). Of 30 patients with a firm gland, none experienced crPOPF. Twenty-five received a partial course of pasireotide; 7/25 (28%) crPOPFs occurred versus 14/75 (19%) in patients receiving a full course (p = 0.38). Conclusion: Shortened courses of pasireotide do not increase crPOPF risk; selective discontinuation may be suitable in low-risk patients. Smoking cessation should be encouraged.

Automated summary

Postoperative pancreatic fistulas (POPFs) are common complications that often require intervention. Pasireotide is a commonly used preventive measure, but the risk factors for POPFs in patients receiving pasireotide have not been explored. This study found that current smoking was significantly associated with clinically-relevant POPF. Additionally, shortening the course of pasireotide did not increase the risk of clinically-relevant POPF, suggesting that selective discontinuation may be suitable for low-risk patients.