Role of Prophylactic Octreotide in Pancreaticoduodenectomy: A Single Centre Comparative Study in 456 Whipple's Patients

Introduction Prophylactic octreotide is controversial in pancreatic surgery in prevention of complications and severity of post-operative pancreatic fistula. We aimed to investigate the influence of prophylactic Octreotide in patients undergoing Pancreaticoduodenectomy and evaluate the cost effectiveness. Methods Prospectively collected data from patients undergoing pancreaticoduodenectomy resections from 2003-2013 (n=456) who had prophylactic subcutaneous administration of octreotide (octreotide group n=255) were compared to patients having pancreaticoduodenectomy where octreotide was not used (no octreotide group n=201). Results Patient groups were well matched with regards to age (p=0.85), sex (p=0.395), and pathology (p=0.79). No octreotide group was associated with reduced hospital stay [octreotide group 20.3 vs. no octreotide group 17.9 days, p<0.001], lower postoperative morbidity [octreotide group n=131(51.4%) vs. no octreotide group n=59(29.3%), p<0.001], and lower significant complications (Clavien Grade II-V), [octreotide group n=94(36%) vs. no octreotide group n=31(15%), p<0.001]. The octreotide group was also associated with significantly higher rate of overall post-operative pancreatic fistula (ISGPF A-C) and serious fistulae (ISGPF B&C) [octreotide group n=75(29.4%) vs. no octreotide group n=42(20.9%), p<0.001] and [octreotide group n=68(27%) vs. no octreotide group n=21(10.4%), p=0.001] respectively. Patients receiving Octreotide were £2370 more expensive to treat. Conclusion Prophylactic octreotide has no role in preventing post-operative pancreatic fistula following Pancreaticoduodenectomy and is associated with increased overall morbidity more severe fistula formation, longer hospital stay & cost of hospitalisation.