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Postoperative Fat Absorptive Function and Glucose Metabolism: Does Age Affect Outcomes Following Pancreatoduodenectomy?
Masahiko Morifuji*1,2, Yasushi Hashimoto2, Naoya Nakagawa2, Kenichiro Uemura2, Yoshiaki Murakami2
1Sanmu Medical Center, Chiba, Japan; 2Applied Life Sciences Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
Background: Postoperative exocrine pancreatic insufficiency and resultant maldigestion is multifactorial in nature, mainly influenced by patient-specific features of the pancreas; however, the impact of advancing age is less well understood. The aim was to evaluate the effect of aging on postoperative digestive and fat absorptive disturbances following pylorus-preserving pancreatoduodenectomy (PPPD).
Methods: A prospectively collected, IRB approved database at a single institution was reviewed. Patients with an aged greater than or equal to 75 (elderly group) were compared to those with an aged less than 75 prior to surgery (control group). An optimized 13C-mixed triglyceride breath test [13C-MTG-T] using a labeled long-chain triglyceride mixture was performed to assess postoperative fat absorptive function after PPPD. Pancreatic exocrine insufficiency was defined as cumulative 7-hour 13CO2 exhalation [% dose 13C cum 7h] < 5%. Pre and postoperative HbA1c levels were measured in blood samples to assess glucose metabolism function. Diabetic patients were identified as those treated with insulin, oral hypoglycemic medications, or having an HbA1c level ≥ 6.9% (NGSP). Data pertaining [13C-MTG-T], HbA1c levels, oral pancreatic enzyme requirements, and body mass index (BMI) were measured at 1 year following surgery. Post-operative fat absorptive function was compared with pre- and post-operative patient's characteristics and glucose metabolism.
Results: Consecutive 51 patients were identified from April 2005 to 2009. The elderly group (≥75 years) included 18 patients, while the remaining 33 patients were assigned as the control group (<75 years). The % dose 13C cum 7h was significantly higher in the elderly group (6.5 ± 5.1%) compared to the control group (3.3 ± 2.4%; P<0.05). The number of patients requiring oral pancreatic enzyme was significantly higher in the elderly group (12 of 18; 83%) comparing to the control group (11 of 33; 33%; P<0.05). The difference in either HbA1c or body mass index (BMI) between the two groups is not statistically significant.
Conclusion: Aging is not associated with impaired pancreatic exocrine function following PPPD compared to the younger patients, and that cumulative 7-hour 13CO2 exhalation of 13C-mixed triglyceride breath test is an important predictive marker of exocrine pancreatic insufficiency, even in a subclinical condition. These findings may have potential implications for the selection of therapeutic strategies in the clinical setting.
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