The usefulness of preoperative exocrine function evaluated by the 13C-trioctanoin breath test as a significant physiological predictor of pancreatic fistula after pancreaticoduodenectomy

• Published in: BMC surgery Vol. 22; no. 1; pp. 1 - 49
• Main Authors: 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
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 11.02.2022; BioMed Central; BMC
• Subjects: 13C-trioctanoin breath test; Absorption; Adenocarcinoma; Analysis; Blood; Breath tests; Confidence intervals; Enzymes; Feces; Fistula; Fistulae; Medical colleges; Medical research; Medicine, Experimental; Mortality; Multivariate analysis; Pancreas; Pancreatic cancer; Pancreatic fistula; Pancreaticoduodenectomy; Patients; Physiological aspects; Physiology; Postoperative fat absorption; Regression analysis; Risk factors; Statistical analysis; Sutures; United States > US
• ISSN: 1471-2482; 1471-2482
• DOI: 10.1186/s12893-022-01500-7

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 13 C-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 13 C-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 13 C-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 13 C-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 13 C-trioctanoin breath test is a feasible and objective predictor of PF after PD.