{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T18:38:12Z","timestamp":1776883092481,"version":"3.51.2"},"reference-count":33,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2014,10,16]],"date-time":"2014-10-16T00:00:00Z","timestamp":1413417600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2014,10,16]],"date-time":"2014-10-16T00:00:00Z","timestamp":1413417600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2015,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>There are only a few reports concerning long\u2010term exocrine function after pancreaticoduodenectomy (PD), although the number of long\u2010term survivors has increased. We assessed pancreatic exocrine function after PD in 189 patients to identify risk factors for pancreatic exocrine insufficiency.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We evaluated patients\u2019 exocrine function by using the <jats:sup>13<\/jats:sup>C\u2010labeled 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\u2010term morphological changes of remnant pancreas by computed tomography (main pancreatic duct dilation and parenchymal atrophy), nutritional status, and endocrine function.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Independent risk factors for exocrine insufficiency after PD include hard pancreas (<jats:italic>P<\/jats:italic> = 0.003, odds ratio; 3.157) and PG reconstruction (<jats:italic>P<\/jats:italic> = 0.040, odds ratio; 2.321). Breath test results correlated significantly with post\u2010operative 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our results showed that PJ reconstruction might be superior to PG during PD, from the viewpoint of long\u2010term pancreatic exocrine function, although further prospective studies are needed.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-014-2832-4","type":"journal-article","created":{"date-parts":[[2014,10,15]],"date-time":"2014-10-15T14:40:24Z","timestamp":1413384024000},"page":"516-525","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":49,"title":["Identification of Risk Factors for Pancreatic Exocrine Insufficiency After Pancreaticoduodenectomy Using a <sup>13<\/sup>C\u2010Labeled Mixed Triglyceride Breath Test"],"prefix":"10.1002","volume":"39","author":[{"given":"Seiko","family":"Hirono","sequence":"first","affiliation":[{"name":"Second Department of Surgery Wakayama Medical University, School of Medicine 811\u20101 Kimiidera 641\u20108510 Wakayama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshiaki","family":"Murakami","sequence":"additional","affiliation":[{"name":"Department of Surgery, Institute of Biomedical and Health Sciences Hiroshima University 1\u20102\u20103 Kasumi, Minami\u2010ku 734\u20108551 Hiroshima Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masaji","family":"Tani","sequence":"additional","affiliation":[{"name":"Second Department of Surgery Wakayama Medical University, School of Medicine 811\u20101 Kimiidera 641\u20108510 Wakayama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manabu","family":"Kawai","sequence":"additional","affiliation":[{"name":"Second Department of Surgery Wakayama Medical University, School of Medicine 811\u20101 Kimiidera 641\u20108510 Wakayama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ken\u2010ichi","family":"Okada","sequence":"additional","affiliation":[{"name":"Second Department of Surgery Wakayama Medical University, School of Medicine 811\u20101 Kimiidera 641\u20108510 Wakayama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenichiro","family":"Uemura","sequence":"additional","affiliation":[{"name":"Department of Surgery, Institute of Biomedical and Health Sciences Hiroshima University 1\u20102\u20103 Kasumi, Minami\u2010ku 734\u20108551 Hiroshima Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takeshi","family":"Sudo","sequence":"additional","affiliation":[{"name":"Department of Surgery, Institute of Biomedical and Health Sciences Hiroshima University 1\u20102\u20103 Kasumi, Minami\u2010ku 734\u20108551 Hiroshima 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