Breath metabolite response to major upper gastrointestinal surgery

Abstract Background Esophagectomy and gastrectomy are associated with profound metabolic changes and significant postoperative morbidity. The aim of this prospective clinical study was to determine whether breath analysis can offer novel insight into the surgical metabolic response and identify biomarkers of postoperative complications, including lung injury. Methods Breath samples were collected preoperatively and at 24, 48, 72, 96 and 168 h after esophagectomy ( n = 25) and gastrectomy ( n = 15). Targeted analysis of four prominent breath metabolites was performed by selected ion flow-tube mass spectrometry. Patients with nonsurgical lung injury (community-acquired pneumonia) were recruited as positive controls. Results Perioperative starvation and subsequent reintroduction of nutritional input were associated with significant changes in breath acetone levels. Breath acetone levels fell after esophagectomy ( P = 0.008) and were significantly lower than in gastrectomy patients at postoperative time points 48 ( P