Estimation of Fat Absorption with the ¹³C‐Trioctanoin Breath Test after Pancreatoduodenectomy or Pancreatic Head Resection

Abstract

The aim of this study was to determine if fat absorption is better after pylorus-preserving pancreatoduodenectomy (PPPD) or duodenum-preserving pancreatic head resection (DPPHR) compared with that following pancreatoduodenectomy with gastrectomy (SPD), provided the patients have similar pancreatic exocrine function. Fat absorption was studied using the 13C-trioctanoin breath test in patients who were grouped according to the degree of fibrosis of the pancreatic remnant. The latter was judged by histologically measuring the fibrosis in a transectional wedge of resected pancreas. We evaluated 11 SPD cases, 25 PPPD cases, and 9 DPPHR cases. The 13C excretion rates and cumulative excretion values following DPPHR or PPPD were significantly better than those following SPD. The 13C excretion rates and cumulative values for the patients with > 30% fibrosis of the pancreas were lower than those in patients with < 30% pancreatic fibrosis, regardless of the surgical procedure. The cumulative value in the SPD group, however, was lower than that in the PPPD or DPPHR patients with < 30% pancreatic fibrosis. The results suggested that fat absorption following PPPD or DPPHR is superior to that after SPD in patients with the same fibrotic area of the pancreatic remnant and depends on the degree of fibrosis in the pancreatic remnant.

Outcome of Duodenum-Preserving Resection of the Head of the Pancreas for Intraductal Papillary-Mucinous Neoplasm

“…Furthermore, fat absorption is comparable to that in healthy controls with normal pancreatic function [11]. It is possible to identify the confluence of the pancreatic and the bile duct, and to preserve the bile duct and the papilla of Vater during pancreatic head resection [12].…”

Predictive Factors for Exocrine Pancreatic Insufficiency After Pancreatoduodenectomy with Pancreaticogastrostomy

“…Several published studies have reported that exocrine pancreatic function after PD depends on the degree of fibrosis in the pancreatic remnant [38][39][40][41][42] and/or loss of functional tissue in the distal remnant of the gland resulting from preexisting obstructive pancreatitis secondary to tumor occluding the pancreatic duct. [40][41][42] Furthermore, a strong correlation exists between endocrine tissue loss and extent of fibrosis.…”

Surgical design and outcome of duodenum‐preserving pancreatic head resection for benign or low‐grade malignant tumors

“…The advantage of the procedure is preservation of the duodenum, which has a key role in the digestive function [5,6]. When DPPHR applies to patients with benign or low-grade malignancy, it is important to remove completely the pancreatic head to avoid tumor remnant and pancreatic fistula, because the majority of the patients with these tumors have the normal pancreatic exocrine gland, and variation of the branch duct of the head of the pancreas [7].…”