Author:
Kato Hiroyuki,Asano Yukio,Ito Masahiro,Kawabe Norihiko,Arakawa Satoshi,Shimura Masahiro,Koike Daisuke,Hayashi Chihiro,Kamio Kenshiro,Kawai Toki,Ochi Takayuki,Yasuoka Hironobu,Higashiguchi Takahiko,Tochii Daisuke,Kondo Yuka,Nagata Hidetoshi,Utsumi Toshiaki,Horiguchi Akihiko
Abstract
Abstract
Background
The association between pancreatic fistula (PF) after pancreaticoduodenectomy (PD) and preoperative exocrine function is yet to be elucidated. This study aimed to evaluate the association between the preoperative results of the 13C-trioctanoin breath test and the occurrence of PF, showing the clinical relevance of the breath test in predicting PF.
Method
A total of 80 patients who underwent 13C-trioctanoin breath tests prior to PD from 2006 to 2018 were included in this study. Univariate and multivariate analyses were conducted to reveal the preoperative predictors of PF, showing the association between 13C-trioctanoin absorption and PF incidence.
Results
Among 80 patients (age, 68.0 ± 11.9 years, 46 males and 34 females; 30 pancreatic ductal adenocarcinoma [PDAC]/50 non-PDAC patients), the incidence of PF was 12.5% (10/80). Logistic regression analysis results revealed that the frequency of PF increased significantly as the 13C-trioctanoin breath test value (Aa% dose/h) increased (odd’s ratio: 1.082, 95% confidence interval: 1.007–1.162, p = 0.032). Moreover, the optimal cutoff value of the preoperative fat absorption level to predict PF was 38.0 (sensitivity, 90%; specificity, 74%; area under the curve, 0.78; p = 0.005). Indeed, the incidence of PF was extremely higher in patients whose breath test value was greater than 38.0 (33%, 9/27) compared with that in patients with values less than 38.0 (1.8%, 1/53).
Conclusions
Favorable preoperative fat absorption evaluated using the 13C-trioctanoin breath test is a feasible and objective predictor of PF after PD.
Publisher
Springer Science and Business Media LLC
Reference36 articles.
1. Kimura W, Miyata H, Gotoh M, Hirai I, Kenjo A, Kitagawa Y, Shimada M, Baba H, Tomita N, Nakagoe T. A pancreaticoduodenectomy risk model derived from 8575 cases from a national single-race population (Japanese) using a web-based data entry system: the 30-day and in-hospital mortality rates for pancreaticoduodenectomy. Ann Surg. 2014;259(4):773–80.
2. Chipaila J, Kato H, Iizawa Y, Motonori N, Noguchi D, Gyoten K, Hayasaki A, Fujii T, Tanemura A, Murata Y, et al. Prolonged operating time is a significant perioperative risk factor for arterial pseudoaneurysm formation and patient death following hemorrhage after pancreaticoduodenectomy. Pancreatology. 2020;20(7):1540–9.
3. Abe K, Kitago M, Shinoda M, Yagi H, Abe Y, Oshima G, Hori S, Yokose T, Endo Y, Kitagawa Y. High risk pathogens and risk factors for postoperative pancreatic fistula after pancreatectomy; a retrospective case-controlled study. Int J Surg. 2020;82:136–42.
4. Okabayashi T, Maeda H, Nishimori I, Sugimoto T, Ikeno T, Hanazaki K. Pancreatic fistula formation after pancreaticooduodenectomy; for prevention of this deep surgical site infection after pancreatic surgery. Hepatogastroenterology. 2009;56(90):519–23.
5. Sugiura T, Uesaka K, Ohmagari N, Kanemoto H, Mizuno T. Risk factor of surgical site infection after pancreaticoduodenectomy. World J Surg. 2012;36(12):2888–94.