Value of pancreatic duct stent placement combined with octreotide for reducing the postoperative pancreatic fistula rate in patients with diabetes undergoing pancreaticoduodenectomy

Abstract

BACKGROUND

Pancreaticoduodenectomy (PD) carries high postoperative complication risks, and postoperative pancreatic fistula is most common. Diabetes further elevates this risk due to impaired healing and immunity. Pancreatic duct stents and octreotide are widely used for prevention, but relevant studies targeting diabetic patients remain insufficient. This study explored the combined application of the two interventions.

AIM

To investigate the effect of combined therapy on postoperative pancreatic fistula in diabetic PD patients.

METHODS

Data from 156 patients with diabetes who underwent PD at our hospital from January 2022 to September 2025 were collected. The patients were divided into a combination group and a control group. In the control group, pancreatic duct stent was placed intraoperatively and routine postoperative care was given. In the combination group, intravenous octreotide infusion was added postoperatively. The incidence of postoperative pancreatic fistula, duration of drain retention, glycemic variability, and length of hospital stay were compared between the two groups.

RESULTS

A total of 60 patients were included in each group, and baseline characteristics were comparable. The incidence of postoperative pancreatic fistula in the combination group was 11.7%, significantly lower than that in the control group (23.3%; odds ratio = 0.43, 95%CI: 0.21-0.89, P = 0.022). The combination group also had significantly shorter drain retention days (8.8 ± 3.5 days vs 12.1 ± 4.8 days, P = 0.018) and postoperative hospital stay (14.5 ± 5.3 days vs 19.2 ± 7.1 days, P = 0.026). No significant inter-group differences were found in mean blood glucose, blood glucose coefficient of variation, daily insulin dosage and the incidence of hypoglycemic events (all P > 0.05).

CONCLUSION

In diabetic patients undergoing PD, the combined regimen was associated with a reduced incidence of postoperative pancreatic fistula, shorter drainage duration, and a shorter hospital stay without significantly affecting postoperative glycemic variability.

Key Words: Pancreaticoduodenectomy; Diabetes mellitus; Postoperative pancreatic fistula; Pancreatic duct stent; Octreotide

Core Tip: This propensity score-matched study in diabetic patients undergoing pancreaticoduodenectomy shows that adding postoperative octreotide to pancreatic duct stent placement significantly reduces clinically relevant postoperative pancreatic fistula (11.7% vs 23.3%), shortens drain retention and hospital stay, and does not affect overall postoperative glucose metabolism. The combined mechanical and pharmacological approach appears safe and beneficial for the type 2 diabetic patients included in this single-center retrospective cohort.

INTRODUCTION

Pancreaticoduodenectomy (PD) is mainly used to treat malignant tumors such as pancreatic head cancer and periampullary cancer. The operation involves multiple organs, is complex and invasive, and has a high incidence of postoperative complications[1,2]. Among them, postoperative pancreatic fistula is the most common after PD, which can lead to dangerous consequences such as pancreatic fistula, abdominal infection, multiple organ failure and even death[3]. Its occurrence mechanism involves a variety of factors such as pancreatic texture, main pancreatic duct diameter, anastomosis technique, postoperative pancreatic juice secretion load, and the patient’s overall condition. The currently recognized high-risk factors include: pancreas-specific factors (soft pancreatic texture and a main pancreatic duct diameter < 3 mm) and patient/surgery-related factors (large intraoperative blood loss, preoperative hypoalbuminemia, and weight loss)[4,5]. Among these, diabetic patients often have decreased tissue healing ability, impaired immune function, and microcirculatory disorders due to long-term glucose metabolism disorders, resulting in a higher risk of postoperative adverse events[6,7]. Specifically, impaired tissue repair capacity directly weakens the healing of pancreaticojejunal anastomosis, and microcirculatory disturbances reduce local blood perfusion of the anastomotic stoma. These pathological changes make diabetic patients more vulnerable to pancreatic juice erosion and increase the risk of postoperative pancreatic fistula after PD. Therefore, it is of important to explore more effective postoperative pancreatic fistula prevention strategies for this high-risk group. Currently, the main measures to reduce the risk of postoperative pancreatic fistula after PD surgery include mechanical drainage and drug inhibition. The former involves placing a stent in the pancreatic duct during surgery to drain pancreatic juice into the intestinal lumen or outside the body to avoid leakage of pancreatic juice and erosion and stimulation of the anastomosis[8]; the latter involves using somatostatin or its analogue octreotide after surgery to inhibit pancreatic exocrine function while reducing intestinal peristalsis , reducing pancreatic juice secretion, and reducing the erosion of the anastomosis by pancreatic juice[9]. However, most clinical studies and meta-analyses are conducted in the general PD patient population, and studies on the specific high-risk subgroup of diabetic patients are relatively scarce. Due to insulin resistance, impaired pancreatic β-cell function, and abnormal glucagon secretion, the pancreatic pathophysiological state of diabetic patients is significantly different from that of non-diabetic patients, and their prognostic risk and even mortality risk are higher[10,11]. In summary, the combined application of pancreatic duct stents and octreotide may become a key direction for the application of PD in diabetic patients after surgery. Pancreatic duct stent placement focuses on reducing intraductal pressure and pancreatic juice leakage from the perspective of anatomical structure and mechanics[12], while octreotide inhibits pancreatic juice secretion and regulates the body’s metabolic response from the perspective of physiological function[13]. The two have complementary mechanisms of action, which can reduce pancreatic juice secretion, reduce local irritation of the anastomosis, and improve the local microenvironment to improve the quality of anastomosis healing. In addition, the combined regimen may help reduce infection risk and promote tissue repair for patients with abnormal glucose metabolism. Based on this, this study aims to preliminarily evaluate the effectiveness of pancreatic duct stent placement combined with octreotide among type 2 diabetic patients undergoing PD in our center, further analyze the safety and feasibility of the combined regimen in this specific cohort, provide reference for clinical decision-making, and provide new ideas and reference directions for the joint research of pancreatic surgery and diabetic surgery combined with surgical diseases.

MATERIALS AND METHODS

Data from 156 patients with diabetes who underwent PD at our hospital from January 2022 to September 2025 were collected.

Inclusion criteria

(1) Diagnosed with type 2 diabetes before surgery and met the diagnostic criteria of the Chinese Guidelines for the Prevention and Treatment of Type 2 Diabetes[14], with complete medical history and blood glucose test data; (2) Underwent standard PD; (3) Intraoperative records showed successful placement of pancreatic duct stents; and (4) Complete clinical data, surgical records, postoperative complications and hospitalization-related data.

Exclusion criteria

(1) Severe dysfunction of important organs such as heart, liver, and kidney; (2) Patients with pancreatitis or abdominal infection; (3) Patients with allergy to octreotide or research-related drugs; (4) Patients with severe infection, coagulation dysfunction or autoimmune disease before surgery; and (5) Patients with missing clinical data who could not be statistically analyzed. Based on the treatment methods recorded in the postoperative treatment records, patients were divided into a combined group (pancreatic duct stent placement combined with octreotide) and a control group (single pancreatic duct stent placement). The two groups underwent 1:1 nearest-neighbor propensity score matching with a caliper value of 0.02. Included variables included age, gender, body mass index, duration of diabetes, glycated hemoglobin (HbA1c), pancreatic texture, main pancreatic duct diameter, pathological type, intraoperative blood loss, operative time, anastomotic details, and combined vascular resection. After matching, 60 patients were included in each group. Baseline balance was comprehensively evaluated by P values and standardized mean difference (SMD); an SMD < 0.1 was defined as good between-group balance, and all indicators were balanced and comparable after matching (P > 0.05).

Research methods

Surgical treatment: According to the query of medical records, the screened patients were all performed PD by senior surgeons (who had completed more than 75 PD surgeries before 2022[15]) to eliminate the confounding factor of doctor experience. According to the hospital database query, cases undergoing standard PD were screened, including resection of the head of the pancreas, duodenum, gallbladder, lower common bile duct, part of the stomach, and proximal jejunum. All cases used pancreatic duct mucosal end-to-side PD, but the specific suture spacing, anastomotic tension and other operational details were determined according to each surgeon’s practice, so there were certain limitations. At the same time, data on concurrent portal vein or superior mesenteric vein resection and reconstruction were retrospectively extracted to reduce the interference of the above-mentioned confounding factors on the research results. In the control group, a straight polyurethane pancreatic duct stent without side holes was placed in the main pancreatic duct during the operation: A 5 Fr stent was used for main pancreatic duct diameter ≤ 3 mm, and a 7 Fr stent was used for diameter > 3 mm, with a length of 6-8 cm; one end of the stent was inserted 2 cm into the pancreatic duct, and the other end was introduced into the jejunum to achieve intraluminal drainage of pancreatic juice. No ligation or clamping of the main pancreatic duct was performed during the operation. Postoperatively, patients received routine treatment including fasting, gastrointestinal decompression, intravenous fluid replacement, enteral/parenteral nutrition support, antibiotic prophylaxis, insulin regulation of blood glucose, and maintenance of fluid, electrolyte, and acid-base balance; no somatostatin analogues were used. On the basis of the control group, the combined group started continuous intravenous infusion of octreotide acetate within 6 hours after surgery: Octreotide at a concentration of 6 μg/mL was infused at a rate of 25 μg/hour, with a daily dose of 0.6 mg, and was routinely used continuously for 7 days; if there are no abnormal physiological indicators related to postoperative pancreatic fistula on the 3^rd day after surgery, the drug can be stopped as early as 5 days later. Both groups of patients underwent continuous glucose monitoring or finger-prick glucose monitoring. Blood glucose was controlled using an insulin pump or continuous intravenous insulin infusion. No oral hypoglycemic agents were recorded within 1 week postoperatively. Blood glucose levels < 3.9 mmol/L were recorded as hypoglycemic events.

Observation indicators

Incidence of clinically relevant postoperative pancreatic fistula: According to the International Study Group on Pancreatic Fistula criteria[16], the results of postoperative peritoneal drainage amylase detection and clinical intervention records were extracted from the medical records for determination; clinically relevant postoperative pancreatic fistula is defined as: On or after the 3^rd day after surgery, the amylase level in the peritoneal drainage fluid is higher than 3 times the upper limit of the normal value of serum amylase (the upper limit of the normal value of serum amylase in our hospital is 100 U/L, i.e. > 300 U/L), and clinical interventions such as prolonging the drainage time, using antibiotics, percutaneous puncture drainage, endoscopic intervention or reoperation are required. Grade A pancreatic fistula with only abnormal biochemical examination but no clinical treatment is excluded, and the incidence rates of the two groups are calculated. postoperative pancreatic fistula rate = number of cases of clinically relevant postoperative pancreatic fistula/total number of cases × 100%.

Duration of drainage tube indwelling: Surgical dates and removal dates of each abdominal drainage tube were collected and statistically analyzed for both groups of patients. The number of days from the end of surgery to the removal of the last drainage tube was calculated. Removal criteria were determined from the patients’ medical records and typically included a drainage volume < 50 mL/24 hours, no postoperative pancreatic fistula, and no clinical signs of abdominal infection.

Postoperative hospital stay: The operation date and discharge date data of the two groups of patients were collected, and their length of stay was calculated. Discharge criteria were determined based on medical records and discharge summaries.

Blood glucose fluctuation: This study retrospectively extracted data from archived nursing records, blood glucose monitoring sheets and medical orders. Blood glucose test results were collected from nursing records and blood glucose monitoring sheets from days 1 to 7 post-surgery. Testing methods included continuous glucose monitoring or daily finger-prick blood glucose testing (usually 7 times: Before each of the three meals, 2 hours after each of the three meals, and before bedtime). Based on available clinical records, we comprehensively assessed perioperative glucose metabolism with four indicators: Mean blood glucose, blood glucose coefficient of variation (CV), number of hypoglycemic episodes, and average daily insulin dosage. All patients received routine perioperative glucose management following our hospital’s standard clinical protocols. The CV for each patient was calculated as: Standard deviation of blood glucose/mean blood glucose × 100%. Hypoglycemia was defined as blood glucose < 3.9 mmol/L. The average daily insulin dosage during postoperative days 1-7 was summarized from inpatient medication orders. All above indicators were compared between the two groups.

Adverse reactions: All adverse reactions within the 7-day medication period and 3-day follow-up after drug withdrawal were retrospectively collected from medical records, nursing records, laboratory reports, and consultation records. For the combined group receiving octreotide, we intensively monitored three categories of potential adverse events closely associated with the drug and the diabetic population: Glycemic abnormalities (especially hypoglycemia), gastrointestinal motility disorders, and biliary system changes. Gastrointestinal reactions included nausea, vomiting, diarrhea, abdominal distension and decreased intestinal peristalsis. Biliary system-related manifestations covered biliary colic, gallbladder distension and abnormal gallbladder contraction observed by imaging examination. The time, duration and intervention of each hypoglycemic episode as well as local injection site reactions were recorded. Grading information was extracted from medical records according to the Common Adverse Reactions Assessment Criteria version 4.0, and the differences in the total incidence of adverse reactions and the incidence of ≥ grade 3 serious adverse reactions were compared between the two groups.

Statistical analysis

Data analysis was performed using SPSS 26.0. Continuous data were expressed as mean ± SD, and independent samples t-tests were used for comparisons between groups. Categorical data were expressed as n (%), and χ² tests or Fisher’s exact test were used for comparisons between groups. Propensity score matching was used to eliminate baseline confounding factors between groups; The SMD was used to assess the matching quality, and SMD < 0.1 indicated ideal baseline balance. P > 0.05 was considered statistically insignificant.

RESULTS

Comparison of baseline data between the two groups of patients

After PSM matching, the data of 60 patients in each group were included. After matching, the SMD of each indicator was < 0.1, and there was no statistically significant difference in the baseline data between the two groups (P > 0.05). Combining SMD and P value, the baseline characteristics of the two groups were balanced and comparable, see Table 1.

Table 1 Comparison of baseline data between the two groups of patients after propensity score matching, n (%)/mean ± SD.

Index	Combined group (n = 60)	Control group (n = 60)	χ²/t	P value	SMD
					Before matching	After matching
Age (years)	62.5 ± 7.2	61.8 ± 7.5	0.512	0.610	0.359	0.095
Gender			0.138	0.710	0.312	0.067
male	35 (58.33)	33 (55.00)
female	25 (41.67)	27 (45.00)
BMI (kg/m²)	24.2 ± 2.8	23.9 ± 2.9	0.547	0.585	0.342	0.098
Duration of diabetes (year)	8.6 ± 4.2	8.2 ± 4.5	0.501	0.617	0.378	0.092
HbA1c (%)	7.5 ± 1.1	7.4 ± 1.2	0.429	0.669	0.589	0.087
Pancreatic texture			0.134	0.714	0.325	0.067
soft	27 (45.00)	29 (48.33)
hard	33 (55.00)	31 (51.67)
Main pancreatic duct diameter (mm)	2.8 ± 0.9	2.7 ± 0.8	0.608	0.544	0.321	0.095
Intraoperative blood loss (mL)	325.6 ± 112.3	332.4 ± 115.7	0.317	0.752	0.165	0.060
Operation time (minute)	318.5 ± 42.6	323.1 ± 45.2	0.571	0.569	0.231	0.098
Combined vascular resection			0.162	0.689	0.308	0.072
Yes	10 (16.67)	8 (13.33)
No	50 (83.33)	52 (86.67)
Pathological type			0.702	0.705	0.362	0.064
Pancreatic head carcinoma	29 (48.33)	27 (45.00)
Periampullary carcinoma	24 (40.00)	26 (43.33)
Benign pancreatic lesions	7 (11.67)	7 (11.67)
Anastomotic characteristics			0.156	0.693	0.324	0.061
Conventional suture group	30 (50.00)	28 (46.67)
Fine suture group	30 (50.00)	32 (53.33)

BMI: Body mass index.

Comparison of the incidence of clinically relevant postoperative pancreatic fistula between the two groups

The incidence rate of clinically relevant postoperative pancreatic fistula in the combined group was 11.7% (7/60), which was significantly lower than that in the control group [23.3% (14/60)], and the difference was statistically significant [odds ratio (OR) = 0.43, 95%CI: 0.21-0.89, χ² = 5.250, P = 0.022].

Comparison of drainage tube indwelling and postoperative hospital stay days between two groups

The combined group had significantly shorter drainage tube retention days and postoperative hospital stays than the control group, with statistically significant differences (P < 0.05) (Table 2).

Table 2 Comparison of the number of days of drainage tube indwelling and the number of days of postoperative hospitalization between the two groups, mean ± SD.

Index	Combined group (n = 60)	Control group (n = 60)	t	P value
Number of days for drainage tube to remain in place	8.8 ± 3.5	12.1 ± 4.8	2.391	0.018
Postoperative hospital stay	14.5 ± 5.3	19.2 ± 7.1	2.254	0.026

Comparison of postoperative blood glucose fluctuations between the two groups

There were no statistically significant differences in the average blood sugar, blood sugar CV, average daily insulin dosage, and number of hypoglycemia episodes 1 to 7 days after surgery between the two groups (P > 0.05). Combining multiple evaluation indicators, the data suggest that short-term perioperative use of octreotide is not associated with significant changes in glucose metabolism in these diabetic patients (Table 3).

Table 3 Comparison of postoperative glucose metabolism related indicators between the two groups, n (%)/mean ± SD.

Index	Combined group (n = 60)	Control group (n = 60)	t/χ²	P value
Mean blood glucose (mmol/L)	8.7 ± 1.4	8.5 ± 1.3	0.802	0.424
Blood glucose CV (%)	24.5 ± 4.1	23.2 ± 3.8	0.997	0.318
Average daily insulin dosage (U/day)	38.6 ± 9.2	37.4 ± 8.8	0.735	0.463
Number of hypoglycemic events	1 (1.7)	0 (0.0)	1.008	0.315

CV: Coefficient of variation.

Occurrence of adverse reactions in the two groups of patients

No grade ≥ 3 severe adverse reactions were observed in either group during treatment. In the combined group treated with octreotide, mild adverse reactions were mainly limited to gastrointestinal symptoms. No sustained hypoglycemia or severe hypoglycemic episodes were detected in diabetic patients; transient blood glucose fluctuations were corrected timely via adjusted insulin dosage. Imaging re-examination revealed no cases of symptomatic gallbladder distension, biliary colic or newly formed gallstones related to biliary stasis. There was no obvious intestinal paralysis or severe gastrointestinal dysmotility. In the control group, only one patient (1.7%) experienced mild nausea. All adverse reactions were grade 1-2 and required no special treatment or resolved rapidly after symptomatic treatment (Table 4).

Table 4 Occurrence of adverse reactions in the two groups of patients, n (%).

Adverse reactions	Combined group (n = 60)	Control group (n = 60)	χ²	P value
Mild diarrhea	3 (5.0)	2 (3.3)	0.210	0.647
Mild nausea	2 (3.3)	1 (1.7)	0.345	0.557
Overall incidence of adverse reactions	5 (8.3)	3 (5.0)	0.536	0.464

DISCUSSION

Diabetes is an independent risk factor for postoperative pancreatic fistula after PD surgery, and it can significantly increase the risk of complications through multiple mechanisms such as reducing tissue healing ability, impairing immune function, and interfering with microcirculation perfusion[17]. This study focused on the high-risk population of patients with diabetes and explored the preventive value of pancreatic duct stent placement combined with octreotide intravenous infusion for postoperative pancreatic fistula after PD surgery. This study suggested that the combined group was better than the control group in terms of the incidence of postoperative pancreatic fistula, the number of days of drainage tube indwelling and the number of days of postoperative hospitalization. There was no significant difference in the postoperative blood glucose fluctuation between the two groups, and the incidence of adverse reactions was low and mainly mild. These findings provide reliable observational evidence for the prevention of postoperative pancreatic fistula after PD surgery in diabetic patients.

The study showed that after propensity score matching and baseline balancing, the incidence of clinically relevant postoperative pancreatic fistula in the combined group was 11.7%, which was significantly lower than 23.3% in the control group. This suggests that combining octreotide with pancreatic duct stent placement can further reduce the risk of postoperative pancreatic fistula after PD surgery in diabetic patients. Pancreatic duct stents are mechanical interventions and are described in surgical records as mainly used to establish a low-resistance drainage path for pancreatic juice, reduce pancreatic duct pressure through intraluminal drainage, and avoid pancreatic juice accumulation that stimulates the anastomosis[17]. Octreotide, as a somatostatin analog, can effectively inhibit pancreatic exocrine secretion, reduce pancreatic juice volume and reduce intestinal peristalsis, thereby reducing the continuous stimulation of the anastomosis by pancreatic juice from a physiological perspective[19,20]. Considering that diabetic patients have inherent defects in tissue repair and microcirculation, the pancreaticojejunal anastomosis is more vulnerable to persistent irritation from pancreatic juice. Single stent drainage is difficult to fully eliminate such risks. The combined strategy integrates physical drainage and functional inhibition to jointly protect the anastomosis, which matches the pathological features of the enrolled diabetic cohort.

Regarding postoperative rehabilitation indicators, the combined group had significantly shorter drainage tube retention days (8.8 ± 3.5 days) and postoperative hospital stay (14.5 ± 5.3 days) than the control group, reflecting a faster overall recovery process after surgery in the combined group. This result is related to the decrease in the incidence of postoperative pancreatic fistula. Postoperative pancreatic fistula is the most important cause of drainage tube retention, abdominal infection, delayed gastric emptying and prolonged hospital stay[21,22]. When pancreatic juice leakage is effectively controlled, the abdominal inflammatory response is reduced, the drainage volume and amylase level drop to the safe range more quickly, the extubation indication can be reached earlier, and thus the hospital stay is shortened[23]. In addition, while inhibiting pancreatic juice secretion, octreotide can reduce postoperative intestinal wall edema and improve the intra-abdominal environment, which can accelerate the recovery of gastrointestinal function and wound healing[24,25]. In this study, the average length of hospital stay in the combined group was shortened by nearly 5 days. Shorter hospital stay helps lower the risk of nosocomial infection and facilitates postoperative recovery. The findings also suggest that this combined regimen has potential application value within the framework of enhanced recovery after surgery[26].

Stable blood glucose is a core goal of perioperative management in diabetic patients. Octreotide may simultaneously inhibit the secretion of insulin and glucagon, theoretically posing a risk of interfering with blood glucose homeostasis. This is the main reason for clinical concerns regarding the use of octreotide in diabetic patients. This study used a comprehensive evaluation system including average blood glucose, blood glucose CV, insulin dose and hypoglycemic events to evaluate glucose metabolism, suggesting that under relatively standardized blood glucose monitoring and insulin regulation as in this study, octreotide does not significantly exacerbate postoperative blood glucose fluctuations in diabetic patients. The reasons may include: First, this study used a short-term intravenous infusion method postoperatively, with standardized dosage and fixed treatment course, resulting in limited interference with the endocrine axis; second, both groups used target blood glucose management (7.8-10.0 mmol/L), combined with dynamic or intensive finger-prick blood glucose monitoring, which could promptly correct abnormal fluctuations; third, the reduced risk of postoperative pancreatic fistula brought about by octreotide can reduce risk factors such as infection and stress that lead to drastic increases in blood glucose, thus having an indirect protective effect on blood glucose stability overall.

Although the incidence of postoperative pancreatic fistula is low, a small number of patients still develop fistulas. Chronic diabetic tissue and microcirculatory disorders, individual pancreatic characteristics, and limited drug efficacy limit therapeutic efficacy. The role of octreotide in preventing postoperative pancreatic fistula after PD remains controversial, its advantages are more prominent among high-risk groups such as diabetics[27,28]. It is therefore more appropriate to use this combination treatment selectively.

In terms of safety, no serious adverse reactions of grade 3 or above occurred in either group. The combined group only experienced mild diarrhea, nausea and other grade 1-2 reactions, with no significant difference in incidence compared to the control group. These reactions could be relieved without special treatment. No serious drug-related events such as symptomatic gallstones or severe hypoglycemia occurred. This result is consistent with the safety profile of octreotide, suggesting that the overall safety record is good under short-term use[29]. Octreotide, a somatostatin analogue, can theoretically inhibit both insulin and glucagon secretion, which may increase the risk of hypoglycemia in diabetic patients receiving perioperative insulin therapy. However, the results of this study showed that only one case of transient mild hypoglycemia was observed, and no severe or recurrent hypoglycemic events occurred. This favorable safety profile may be related to standardized real-time glucose monitoring and flexible insulin dose adjustment during hospitalization. In terms of gastrointestinal function, short-term intravenous infusion of octreotide only caused mild diarrhea and occasional nausea in a few patients, but did not induce severe intestinal motility disorders or postoperative intestinal obstruction. Regarding the biliary system, short-term use of octreotide reduces gallbladder contraction; however, we found no symptomatic biliary lesions or new gallstones during follow-up, suggesting that short-term perioperative use is unlikely to increase biliary risk. Overall, short-term perioperative use of octreotide showed an acceptable safety profile in diabetic patients undergoing PD, with associated adverse effects being mild and controllable under standardized clinical monitoring.

This study also has certain limitations. First, it was a single-center retrospective study, and although propensity score matching was used to reduce confounding factors, selection bias could not be completely eliminated. Second, the sample size was limited, including only 60 matched patients. Subgroup analyses stratified by HbA1c level, diabetes duration, pancreatic texture, or main pancreatic duct diameter were not possible, resulting in an inability to distinguish varying degrees of clinical benefit in patients with diabetes with different glycemic control status and disease duration; and subgroup analysis was not possible based on different pancreatic textures, pancreatic duct diameters, and duration of diabetes. The optimal beneficiary population for the combined regimen still needs further refinement. Third, long-term follow-up was not conducted, and indicators such as long-term complications and tumor prognosis were not assessed. In addition, although pancreatic duct mucosal end-to-side PD was restricted to surgeons with sufficient PD experience, due to the retrospective nature of this study, suture spacing and anastomotic tension were determined by each surgeon’s routine practice. This subtle intraoperative difference cannot be completely eliminated and has certain limitations. Future research could involve multicenter, prospective, randomized controlled trials to expand the sample size, carry out subgroup stratification according to HbA1c levels and diabetes duration, refine subgroup stratification, and extend the follow-up period to further validate the long-term efficacy and safety of the combined regimen in diabetic patients after PD surgery.

CONCLUSION

This study, based on single-center retrospective clinical data, used propensity score matching analysis to find that among the included type 2 diabetic patients who underwent PD, the combination of pancreatic duct stent placement and postoperative octreotide intravenous infusion was associated with a lower incidence of postoperative pancreatic fistula, shorter drainage tube indwelling days, and shorter postoperative hospital stays. No significant effect of this combination regimen on glycemic variability was observed. This finding provides observational evidence based on real-world clinical data for the prevention of postoperative pancreatic fistula in diabetic patients.