Are Somatostatin or Its Synthetic Analogues Helpful in Reducing Pancreatic Fistula?

creatic fistula (19.4%) of which 55 patients were excluded from the analysis, because they received octreotide later than 24 h after surgery. Of the remaining 78 patients, 22 were treated with octreotide. Comparing the 22 patients with octreotide with the 56 patients without, the authors found that the lipase activity was not influenced by octreotide and that length of postoperative hospital stay was not different. In addition, patients receiving octreotide developed more grade B and C fistula. Therefore the authors concluded that octreotide was not helpful in prevention or treatment of pancreatic fistula. How should we interpret this study? The administration of prophylactic octreotide was based on the surgeon’s decision and was not started preoperatively as in the published randomized controlled trials. In other words, the attending surgeon decided to administer octreotide based on certain risk factors for pancreatic fistulas such as the texture of the pancreas, type and duration of surgery, nutritional status of the patient, blood loss, secondary diagnoses, ASA score and tumor stage. Therefore, fistula rates may differ between patient groups based on selection bias, which is strong in this type of retrospective analysis. Moreover, only 22 patients received octreotide which is by far not sufficient to exclude that the above risk factors were not responsible for the higher rate of grade B and C fistula in the octreotide group. This study therefore does not support either using or abandoning octreotide and is in good company with the other publications.