As pancreatic surgeons, we know all too well how hard it is to carry out randomized clinical trials in our field. Therefore, in striving for the best evidence-based solutions to combat the sequelae of pancreatectomies, we are grateful to Tarvainen and colleagues1 for providing us the Hydrocortisone vs Pasireotide in Reducing Pancreatic Surgery Complications trial in this issue of JAMA Surgery. We are offered a demonstration that perioperative administration of hydrocortisone is not significantly worse compared with the more-expensive option of pasireotide in terms of overall complication burden (measured by the Comprehensive Complication Index) following different types of pancreatectomies. Pasireotide is, however, associated with a lower rate of clinically relevant postoperative pancreatic fistulas in the subgroup of distal pancreatectomies. Unfortunately, the article is unclear on which of these outcomes (overall burden vs fistula) is the real focus of the investigation.
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Casciani F, Vollmer CM. Pasireotide and Corticosteroids for Prevention of Pancreatic Fistula—Over-HYPed? JAMA Surg. 2020;155(4):299. doi:10.1001/jamasurg.2019.6020
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