title: Prophylactic octreotide for pancreatoduodenectomy: more harm than good?
abstract: BACKGROUND
  Most accrued evidence regarding prophylactic octreotide for a pancreatoduodenectomy (PD) predates the advent of the International Study Group of Pancreatic Fistula (ISGPF) classification system for a post-operative pancreatic fistula (POPF), and its efficacy in the setting of high POPF risk is unknown. The Fistula Risk Score (FRS) predicts the risk and impact of a clinically relevant (CR)-POPF and can be useful in assessing the impact of octreotide in scenarios of risk.
  
  
  METHODS
  From 2001-2013, 1018 PDs were performed at four institutions, with octreotide administered at the surgeon's discretion. The FRS was used to analyse the occurrence and burden of POPF across various risk scenarios.
  
  
  RESULTS
  Overall, 391 patients (38.4%) received octreotide. A CR-POPF occurred more often when octreotide was used (21.0% versus 7.0%; P < 0.001), especially when there was advanced FRS risk. Octreotide administration also correlated with an increased hospital stay (mean: 13 versus 11 days; P < 0.001). Regression analysis, controlling for FRS risk, demonstrated that octreotide increases the risk for CR-POPF development.
  
  
  CONCLUSIONS
  This multi-institutional study, using ISGPF criteria, evaluates POPF development across the entire risk spectrum. Octreotide appears to confer no benefit in preventing a CR-POPF, and may even potentiate CR-POPF development in the presence of risk factors. This analysis suggests octreotide should not be utilized as a POPF mitigation strategy.
authors.affiliation: Departments of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: McMillan
authors.forename: John D
authors.initials: JD
authors.lastname: Christein
authors.forename: Mark P
authors.initials: MP
authors.lastname: Callery
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Behrman
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Drebin
authors.forename: Tara S
authors.initials: TS
authors.lastname: Kent
authors.forename: Benjamin C
authors.initials: BC
authors.lastname: Miller
authors.forename: Russell S
authors.initials: RS
authors.lastname: Lewis
authors.forename: Charles M
authors.initials: CM
authors.lastname: Vollmer
mesh_terms: D004334:Drug Administration Schedule; D006801:Humans; D015282:Octreotide / Q000008:administration & dosage* / Q000009:adverse effects*; D010185:Pancreatic Fistula / Q000139:chemically induced* / Q000175:diagnosis; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D015282:Octreotide