Disturbances of the Perioperative Microbiome Across Multiple Body Sites in Patients Undergoing Pancreaticoduodenectomy

Abstract

Objective The goal of this study was to characterize bacterial communities within fecal samples, pancreatic fluid, bile, and jejunal contents from patients undergoing pancreaticoduodenectomy (PDA), and to identify associations between microbiome profiles and clinical variables. Methods Fluid was collected from the pancreas, common bile duct, and proximal jejunum from 50 PDA patients. Postoperative fecal samples were also collected. The microbial burden within samples was quantified with ddPCR. Bacterial 16S ribosomal RNA gene sequences were amplified, sequenced, and analyzed. Data from fecal samples were compared to publicly available data obtained from volunteers. Results ddPCR confirmed the presence of bacteria in all sample types, including pancreatic fluid. Relative to samples from the American Gut Project, fecal samples from PDA patients were enriched with Klebsiella and Bacteroides, and were depleted of anaerobic taxa (e.g. Roseburia and Faecalibacterium). Similar patterns were observed within PDA pancreas, bile, and jejunal samples. Postoperative fecal samples from patients with a pancreatic fistula contained increased abundance of Klebsiella and decreased abundance of commensal anaerobes, e.g. Ruminococcus. Conclusions This study confirms the presence of altered bacterial populations within samples from PDA patients. Future research must validate these findings and may evaluate targeted microbiome modifications to improve outcomes in PDA patients.

The Microbiomes of Pancreatic Tissue in Pancreatic Cancer and Non-Cancer Subjects

“…Consistent with our findings, microbial communities in the pancreas, bile and jejunum fluids were similar within individuals 13 . Mean relative abundance for the bacterial taxa Klebsiella was high in the samples from pancreatic cancer patients in that study 13 ; in our study we found this bacteria to be one of two present on a swab taken of the stent itself. Placement of stent prior to surgery may impact the type of bacteria present in the pancreas, as observed in our study.…”

“…A similar study using swab specimens from the pancreas, bile and jejenum, was conducted on patients with pancreatic cancer undergoing pancreaticoduodenectomy 13 . In that study, a large number of bacteria were present in fluids obtained from the pancreatic ducts and the common bile duct, including Prevotella, Haemophilus, Aggregatibacter, and Fusobacterium 13 . Consistent with our findings, microbial communities in the pancreas, bile and jejunum fluids were similar within individuals 13 .…”

“…Other studies have investigated the presence of specific bacterial DNA in the pancreatic tissue of pancreatic cancer patients, namely species of Helicobacter 11 and Fusobacterium 12 . The most comprehensive microbiome study to date reported the presence of a diverse bacterial population in fluid collected from the bile duct, pancreas and jejunum of patients undergoing pancreaticoduodenectomy 13 .…”

Association of bacteria in pancreatic fistula fluid with complications after pancreatic surgery

“…Indeed, in the authors' clinical experience, short‐lived increases in serum amylase or lipase levels are common in the first 24 h after pancreatic resection, including resection of the tail. Such a translocation may be facilitated by disturbances in the microbiome of patients with pancreatic disease, or by the presence of exocrine pancreatic insufficiency.…”

Beyond Digestion: The Pancreas Shapes Intestinal Microbiota and Immunity

“…Pancreatectomy in humans may represent a valid clinical model to investigate postoperative changes and subsequent effects on the gut microbiota, although such studies are also limited by the fact that this surgical procedure is commonly performed in pancreatic cancers with often limited life expectancy. A first report assessed microbial alterations in fecal samples, pancreatic fluid, bile, and jejunal content of humans undergoing pancreaticoduodenectomy (Rogers et al, 2017). This study describes microbiota alterations with an enrichment of Klebsiella spp.…”