Department of Gastroenterological Surgery, Fujita Health University School of Medicine, Bantane Hospital, 3-6-10 Otobashi Nakagawa Ward, Nagoya, Aichi Prefecture, 454-8509, Japan.
BMC Surg. 2022 Feb 11;22(1):49. doi: 10.1186/s12893-022-01500-7.
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 C-trioctanoin breath test and the occurrence of PF, showing the clinical relevance of the breath test in predicting PF.
A total of 80 patients who underwent 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 C-trioctanoin absorption and PF incidence.
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 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).
Favorable preoperative fat absorption evaluated using the C-trioctanoin breath test is a feasible and objective predictor of PF after PD.
胰十二指肠切除术（PD）后胰瘘（PF）与术前外分泌功能的关系尚未阐明。本研究旨在评估 C-辛酸三甘油酯呼吸试验的术前结果与 PF 发生之间的关系，显示呼吸试验在预测 PF 方面的临床相关性。
本研究共纳入 2006 年至 2018 年间接受 C-辛酸三甘油酯呼吸试验的 80 例 PD 患者。进行单因素和多因素分析以揭示 PF 的术前预测因素，显示 C-辛酸三甘油酯吸收与 PF 发生率之间的关系。
80 例患者（年龄 68.0±11.9 岁，男性 46 例，女性 34 例；30 例胰腺导管腺癌[PDAC]/50 例非 PDAC 患者）中，PF 发生率为 12.5%（10/80）。逻辑回归分析结果显示，随着 C-辛酸三甘油酯呼吸试验值（Aa%剂量/h）的增加，PF 的发生率显著增加（比值比：1.082，95%置信区间：1.007-1.162，p=0.032）。此外，术前脂肪吸收水平预测 PF 的最佳截断值为 38.0（敏感性 90%，特异性 74%，曲线下面积 0.78，p=0.005）。事实上，呼吸试验值大于 38.0 的患者 PF 发生率（33%，9/27）明显高于值小于 38.0 的患者（1.8%，1/53）。
使用 C-辛酸三甘油酯呼吸试验评估的良好术前脂肪吸收是 PD 后 PF 的一种可行且客观的预测指标。
