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• W2171302904 abstract "We appreciate the comments of Yang and colleagues on our recent work entitled ‘Prophylactic octreotide for pancreatoduodenectomy: more harm than good?’1.McMillan M.T. Christein J.D. Callery M.P. Behrman S.W. Drebin V.A. Kent T.S. et al.Prophylactic octreotide for pancreatoduodenectomy: more harm than good?.HPB. 2014; 16: 954-962Abstract Full Text Full Text PDF Scopus (66) Google Scholar We agree with several of their points, particularly that the current evidence in the translational literature directly linking octreotide to the formation of fistulas is far from definitive; however, defining the mechanism of fistula development in the setting of prophylactic octreotide was beyond the scope of our paper. Despite this, we cited over 15 studies that may explain our clinical findings. Secondly, although our findings contrast with those of several randomized controlled trials (RCTs), each of those studies predated the advent of the International Study Group on Pancreatic Fistula,2.Bassi C. Dervenis C. Butturini G. Fingerhut A. Yeo C. Izbicki J. et al.Postoperative pancreatic fistula: an international study group (ISGPF) definition.Surgery. 2005; 138: 8-13Abstract Full Text Full Text PDF PubMed Scopus (3558) Google Scholar which established definitions for clinically relevant postoperative pancreatic fistula (CR-POPF) through international consensus. In fact, although the differences were non-significant, the only RCTs to be conducted since those definitions were published have reported higher rates of fistula formation with octreotide.3.Hesse U.J. DeDecker C. Houtmeyers P. Demetter P. Ceelen W. Pattyn P. et al.Prospectively randomized trial using perioperative low-dose octreotide to prevent organ-related and general complications after pancreatic surgery and pancreatico-jejunostomy.World J Surg. 2005; 29: 1325-1328Crossref PubMed Scopus (43) Google Scholar, 4.Kollmar O. Moussavian M.R. Richter S. de Roi P. Maurer C.A. Schilling M.K. Prophylactic octreotide and delayed gastric emptying after pancreaticoduodenectomy: results of a prospective randomized double-blinded placebo-controlled trial.Eur J Surg Oncol. 2008; 34: 868-875Abstract Full Text Full Text PDF PubMed Scopus (73) Google Scholar The overall fistula rates in our study (octreotide group: 28.1%; control group: 21.5%) compare favourably with those in the most recent RCT (octreotide group: 25%; control group: 18%).4.Kollmar O. Moussavian M.R. Richter S. de Roi P. Maurer C.A. Schilling M.K. Prophylactic octreotide and delayed gastric emptying after pancreaticoduodenectomy: results of a prospective randomized double-blinded placebo-controlled trial.Eur J Surg Oncol. 2008; 34: 868-875Abstract Full Text Full Text PDF PubMed Scopus (73) Google Scholar Contrasting findings were recently reported with the new somatostatin analogue, pasireotide, but the efficacy of this drug has not been tested in a multicentre fashion.5.Allen P.J. Gonen M. Brennan M.F. Bucknor A.A. Robinson L.M. Pappas M.M. et al.Pasireotide for postoperative pancreatic fistula.N Engl J Med. 2014; 370: 2014-2022Crossref PubMed Scopus (271) Google Scholar Lastly, a forthcoming study by our group of outcomes in over 4300 pancreatoduodenectomies performed by 55 surgeons at 15 institutions found octreotide to be associated with a greater incidence of CR-POPF [odds ratio (OR) 3.3; P < 0.0001] similar to the figures reported in our recent paper (OR 2.6; P < 0.001).1.McMillan M.T. Christein J.D. Callery M.P. Behrman S.W. Drebin V.A. Kent T.S. et al.Prophylactic octreotide for pancreatoduodenectomy: more harm than good?.HPB. 2014; 16: 954-962Abstract Full Text Full Text PDF Scopus (66) Google Scholar The later study controlled for elements of endogenous and operative risk, as well as for mitigation strategies (octreotide, drains, stents, etc.), institutional volume and surgeon experience. An important takeaway from that analysis, and our paper on octreotide,1.McMillan M.T. Christein J.D. Callery M.P. Behrman S.W. Drebin V.A. Kent T.S. et al.Prophylactic octreotide for pancreatoduodenectomy: more harm than good?.HPB. 2014; 16: 954-962Abstract Full Text Full Text PDF Scopus (66) Google Scholar is that fistula risk is multifactorial; octreotide was associated with elevated CR-POPF rates, but other factors also rose to statistical significance. We believe it is imperative to control for all components of CR-POPF risk when evaluating the efficacy of fistula mitigation strategies." @default.
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• W2171302904 date "2015-04-01" @default.
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• W2171302904 title "Prophylactic octreotide in pancreatoduodenectomy: response to Yang et al." @default.
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