Somatostatin and its analogs in the management of postoperative pancreatic fistulas: A comprehensive review

A significant post-pancreatic surgery effect we could mention is the postoperative pancreatic fistula (POPF). In this way, it contributes to a large degree to morbidity and long-term recovery. Only clinically significant fistulas (grades B/C) are associated with notable deviations in care according to the current International Study Group on Pancreatic Surgery definitions. The development of POPF depends on many factors. This development includes mechanical damage that occurs at the anastomosis or the stump, and enzymatic autodigestion that results from pancreatic secretions. The somatostatin analogs include octreotide, lanreotide, and pasireotide. Somatostatin and its analogs inhibit exocrine pancreatic secretion and have been shown to be used as preventive agents. The data from clinical trials and meta-analyses remain questionable even today, and it has been found in some studies that it reduces the overall rate of fistulas. On the other hand, there is another view that the stable benefit in clinical relative POPF morbidity or survival has not yielded the desired results. Today, instead of universal prophylaxis, the use of somatostatin is recommended as part of a multimodal perioperative management. However, it has also been found that somatostatin may have positive effects only in certain patients. Ongoing research should aim to clarify the best patient selection. Additionally, it should have the goal of not only being economically beneficial but also being integrated into treatment based on somatostatin for the most precise preoperative care.