Dei Hideyuki, Yokoyama Yukihiro, Mizuno Takashi, Asahara Takashi, Igami Tsuyoshi, Natsume Seiji, Shimizu Yasuhiro, Ebata Tomoki
Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan; Division of Perioperative Medicine, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Surgery. 2025 Apr;180:109040. doi: 10.1016/j.surg.2024.109040. Epub 2025 Jan 4.
We previously reported that the balance of short-chain fatty acids and lactic acid in feces affects postoperative infectious complications after major hepatectomy. However, the effect remains unclear in pancreaticoduodenectomy.
Preoperative fecal samples were collected from 210 patients who underwent pancreaticoduodenectomy at 2 institutions between January 2019 and June 2021. Organic acid concentrations were measured per 1 g of feces by high-performance liquid chromatography; the ratio, defined as the sum of acetic, propionic, and butyric acid divided by lactic acid, was calculated. The correlation between the acetic, propionic, and butyric acid divided by lactic acid ratio and postoperative infectious complications was determined using univariate and multivariate analyses.
Sixty-one patients (29%) had postoperative infectious complications, represented by intra-abdominal abscess, cholangitis, and surgical-site infection. Fecal lactic acid levels ranged from 0.13 to 36.98, with a median of 0.69; the median level was 1.10 μmol/g in the postoperative infectious complications group and 0.36 μmol/g in the nonpostoperative infectious complications group (P < .001). The acetic, propionic, and butyric acid divided by lactic acid ratio ranged from 1.65 to 1,753.4, with a median of 105.8; the median ratio was 59.1 in the postoperative infectious complications group and 198.6 in the nonpostoperative infectious complications group (P = .002). Multivariate analysis revealed that a low acetic, propionic, and butyric acid divided by lactic acid ratio (<75) in the preoperative feces was an independent risk factor for postoperative infectious complications, with an odds ratio of 3.5 and a 95% confidence interval of 1.8-7.0 (P < .001). Preoperative biliary drainage was significantly associated with a low acetic, propionic, and butyric acid divided by lactic acid ratio.
The preoperative fecal organic acid profile determined using the acetic, propionic, and butyric acid divided by lactic acid ratio clinically impacted the incidence of postoperative infectious complications in patients who underwent pancreaticoduodenectomy.
我们之前报道过，粪便中短链脂肪酸和乳酸的平衡会影响肝切除术后的感染性并发症。然而，在胰十二指肠切除术中其影响仍不明确。
收集了2019年1月至2021年6月期间在2家机构接受胰十二指肠切除术的210例患者的术前粪便样本。通过高效液相色谱法测定每克粪便中的有机酸浓度；计算乙酸、丙酸和丁酸之和除以乳酸的比值。采用单因素和多因素分析确定乙酸、丙酸和丁酸除以乳酸的比值与术后感染性并发症之间的相关性。
61例患者（29%）发生术后感染性并发症，表现为腹腔脓肿、胆管炎和手术部位感染。粪便乳酸水平为0.13至36.98，中位数为0.69；术后感染性并发症组的中位数水平为1.10μmol/g，非术后感染性并发症组为0.36μmol/g（P <.001）。乙酸、丙酸和丁酸除以乳酸的比值为1.65至1753.4，中位数为105.8；术后感染性并发症组的中位数比值为59.1，非术后感染性并发症组为198.6（P =.002）。多因素分析显示，术前粪便中乙酸、丙酸和丁酸除以乳酸的比值低（<75）是术后感染性并发症的独立危险因素，比值比为3.5，95%置信区间为1.8 - 7.0（P <.001）。术前胆道引流与乙酸、丙酸和丁酸除以乳酸的比值低显著相关。
使用乙酸、丙酸和丁酸除以乳酸的比值确定的术前粪便有机酸谱在临床上影响了接受胰十二指肠切除术患者术后感染性并发症的发生率。
