Lazaridou L, Dimaki A, Vakalou K, Zervas V, Papadopoulos P, Koumarelas KE, Christodoulidis G. Somatostatin and its analogs in the management of postoperative pancreatic fistulas: A comprehensive review. World J Gastrointest Surg 2026; 18(2): 115417 [DOI: 10.4240/wjgs.v18.i2.115417]
Corresponding Author of This Article
Grigorios Christodoulidis, MD, PhD, Doctor, Department of General Surgery, University Hospital of Larissa, Mezourlo, Larissa 41110, Thessalia, Greece. gregsurg@yahoo.gr
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Surgery
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Minireviews
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Feb 27, 2026 (publication date) through Feb 26, 2026
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World Journal of Gastrointestinal Surgery
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1948-9366
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Lazaridou L, Dimaki A, Vakalou K, Zervas V, Papadopoulos P, Koumarelas KE, Christodoulidis G. Somatostatin and its analogs in the management of postoperative pancreatic fistulas: A comprehensive review. World J Gastrointest Surg 2026; 18(2): 115417 [DOI: 10.4240/wjgs.v18.i2.115417]
World J Gastrointest Surg. Feb 27, 2026; 18(2): 115417 Published online Feb 27, 2026. doi: 10.4240/wjgs.v18.i2.115417
Somatostatin and its analogs in the management of postoperative pancreatic fistulas: A comprehensive review
Lydia Lazaridou, Alexandra Dimaki, Kalliopi Vakalou, Vasilios Zervas, Panagiotis Papadopoulos, Konstantinos E Koumarelas, Grigorios Christodoulidis
Lydia Lazaridou, Alexandra Dimaki, Kalliopi Vakalou, Grigorios Christodoulidis, Department of General Surgery, University Hospital of Larissa, Larissa 41110, Thessalia, Greece
Vasilios Zervas, Department of Internal Medicine, General Hospital of Athens “Evaggelismos”, Athens 10076, Greece
Panagiotis Papadopoulos, Department of General Surgery, Spitalverbund Appenzell Ausserrhoden, Spital Herisau, Herisau 9100, Appenzell Ausserrhoden, Switzerland
Konstantinos E Koumarelas, Department of General and Orthopaedic Surgery, Spitalverbund Appenzell Ausserrhoden, Herisau 9100, Appenzell Ausserrhoden, Switzerland
Co-first authors: Lydia Lazaridou and Alexandra Dimaki.
Author contributions: Christodoulidis G designed the overall concept and outline of the manuscript; Lazaridou L and Dimaki A contributed equally to this article and are the co-first authors of this manuscript; Lazaridou L, Dimaki A, Vakalou K, Zervas V, Papadopoulos P, Koumarelas KE and Christodoulidis G contributed to the discussion and design of the manuscript, contributed to the writing, editing the manuscript, and literature review; all authors thoroughly reviewed and endorsed the final manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Corresponding author: Grigorios Christodoulidis, MD, PhD, Doctor, Department of General Surgery, University Hospital of Larissa, Mezourlo, Larissa 41110, Thessalia, Greece. gregsurg@yahoo.gr
Received: October 16, 2025 Revised: November 18, 2025 Accepted: December 17, 2025 Published online: February 27, 2026 Processing time: 133 Days and 11.4 Hours
Abstract
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.
Core Tip: Postoperative pancreatic fistula (POPF) remains a major challenge in pancreatic surgery. Somatostatin and its analogs reduce exocrine secretion and have been widely evaluated for POPF prevention and management. Evidence from recent meta-analyses and randomized trials suggests that while these agents significantly lower POPF incidence, their effect on mortality is minimal. Current research focuses on patient risk stratification and long-acting depot formulations, such as preoperative lanreotide, to enhance compliance and cost-effectiveness. A tailored, risk-adjusted prophylaxis strategy may represent the future standard of care.
