title: Identification of risk factors for pancreatic exocrine insufficiency after pancreaticoduodenectomy using a 13C-labeled mixed triglyceride breath test.
abstract: BACKGROUND
  There are only a few reports concerning long-term exocrine function after pancreaticoduodenectomy (PD), although the number of long-term survivors has increased. We assessed pancreatic exocrine function after PD in 189 patients to identify risk factors for pancreatic exocrine insufficiency.
  
  
  METHODS
  We evaluated patients' exocrine function by using the (13)C-labeled mixed triglyceride breath test, a noninvasive test feasible in outpatient service units. The present study included 99 patients that underwent pancreaticojejunostomy (PJ) at Wakayama Medical University Hospital and 90 patients that underwent pancreaticogastrostomy (PG) at Hiroshima University Hospital, the standard reconstruction techniques during PD at the respective hospitals. We also analyzed long-term morphological changes of remnant pancreas by computed tomography (main pancreatic duct dilation and parenchymal atrophy), nutritional status, and endocrine function.
  
  
  RESULTS
  Independent risk factors for exocrine insufficiency after PD include hard pancreas (P = 0.003, odds ratio; 3.157) and PG reconstruction (P = 0.040, odds ratio; 2.321). Breath test results correlated significantly with post-operative morphological changes, nutritional status, and endocrine function. Atrophic changes of the remnant pancreas in the PG group were more severe than those in the PJ group. Furthermore, for patients with a soft pancreas, postoperative body weight changes, prognostic nutritional index, serum total protein levels as well as exocrine test were worse in the PG group, compared with the PJ group.
  
  
  CONCLUSIONS
  Our results showed that PJ reconstruction might be superior to PG during PD, from the viewpoint of long-term pancreatic exocrine function, although further prospective studies are needed.
authors.affiliation: Second Department of Surgery, Wakayama Medical University, School of Medicine, 811-1 Kimiidera, Wakayama, 641-8510, Japan.
authors.forename: Seiko
authors.initials: S
authors.lastname: Hirono
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Murakami
authors.forename: Masaji
authors.initials: M
authors.lastname: Tani
authors.forename: Manabu
authors.initials: M
authors.lastname: Kawai
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Okada
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Uemura
authors.forename: Takeshi
authors.initials: T
authors.lastname: Sudo
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Hashimoto
authors.forename: Naoya
authors.initials: N
authors.lastname: Nakagawa
authors.forename: Naru
authors.initials: N
authors.lastname: Kondo
authors.forename: Hiroki
authors.initials: H
authors.lastname: Yamaue
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001284:Atrophy / Q000000981:diagnostic imaging / Q000209:etiology; D001944:Breath Tests / Q000379:methods; D002247:Carbon Isotopes; D004108:Dilatation, Pathologic / Q000000981:diagnostic imaging / Q000209:etiology; D010188:Exocrine Pancreatic Insufficiency / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D010179:Pancreas / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging / Q000473:pathology*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000379:methods; D010193:Pancreaticojejunostomy / Q000009:adverse effects*; D011184:Postoperative Period; D011859:Radiography; D012307:Risk Factors; D013270:Stomach / Q000601:surgery*; D014280:Triglycerides / Q000032:analysis; D055815:Young Adult
chemical_list: D002247:Carbon Isotopes; D014280:Triglycerides