Favorable Preoperative Exocrine Function Evaluated by 13C Trioctanoin Breath Test is a Significant Physiological Predictor of Pancreatic Fistula After Pancreaticoduodenectomy

Abstract

Aim The association between the pancreatic fistula (PF) after pancreaticoduodenectomy (PD) and preoperative exocrine function has yet to be elucidated. The aim of this study is to evaluate the association between the preoperative results of 13C-trioctanoin breath test and occurrence of PF, showing the clinical relevancy of the breath test to predict the PF. Method In the present study, the subject were 80 patients who underwent 13C trioctanoin breath test prior to PD from 2006 to 2018. We conducted the uni- and multivariate analyses to reveal the preoperative predictor of PF, showing the association of the 13C trioctanoin absorption and incidence of PF. Results: Among 80 patients (Age:68.0+/-11.9, male/female:46/34, pancreatic ductal adenocarcinoma: PDAC/non-PDAC: 30/50), the incidence of PF is 12.5% (10/80). When we compared the levels of 13C trioctanoin absorption between PF and non-PF group, preoperative fat absorption level is significantly higher than in the PF group than in the non-PF group (41.2+/-5.9 vs. 33.9+/-8.1, p = 0.019). Moreover, optimal cut-off value of the preoperative fat absorption level to predict PF was 38.0 (sensitivity:90%, specificity:74%, AUC:0.78, p = 0.005). Indeed, the incidence of PF was extremely higher in the patients whose value of breath test was greater than 38.0 (33%, 9/27) compared to the patients with those less than 38.0 (1.8%, 1/53). Conclusion Favorable preoperative fat absorption evaluated by 13C trioctanoin breath test is a feasible and objective predictor of PF after PD.