Potential risk factors for nonalcoholic steatohepatitis related to pancreatic secretions following pancreaticoduodenectomy

Abstract

Aim: To identify risk factors for nonalcoholic steatohepatitis following pancreaticoduodenectomy, with a focus on factors related to pancreatic secretions.

Methods: The medical records of 228 patients who had a pancreaticoduodenectomy over a 16-mo period were reviewed retrospectively. The 193 patients who did not have fatty liver disease preoperatively were included in the final analysis. Hepatic steatosis was diagnosed using the differences between splenic and hepatic attenuation and liver-to-spleen attenuation as measured by non-enhanced computed tomography.

Results: Fifteen patients (7.8%) who showed postoperative hepatic fatty changes were assigned to Group A, and the remaining patients were assigned to Group B. Patient demographics, preoperative laboratory findings (including levels of C-peptide, glucagon, insulin and glucose tolerance test results), operation types, and final pathological findings did not differ significantly between the two groups; however, the frequency of pancreatic fistula (P = 0.020) and the method of pancreatic duct stenting (P = 0.005) showed significant differences between the groups. A multivariate analysis identified pancreatic fistula (HR = 3.332, P = 0.037) and external pancreatic duct stenting (HR = 4.530, P = 0.017) as independent risk factors for the development of postoperative steatohepatitis.

Conclusion: Pancreatic fistula and external pancreatic duct stenting were identified as independent risk factors for the development of steatohepatitis following pancreaticoduodenectomy.

Keywords: Nonalco-holic steatohepatitis; Nonalcoholic fatty liver diseases; Pancreatic duct stenting; Pancreatic fistula; Pancreatic surgery.

Figure 1

Preoperative and postoperative non-enhanced computed tomography images of a representative patient demonstrating different attenuation values for the spleen and liver. The inclusion criteria were: (1) CT_S-L ≥ 10 Housefield unit (HU); or (2) CT_L/S ≤ 0.9 HU [L: Mean attenuation value for two random points (1, 2) of the liver; S: Attenuation value for one random point (3) of the spleen]. A: Preoperative; B: Postoperative.

Figure 2

Preoperative oral glucose tolerance test results, continuous stimulation test results for insulin, C-peptide, and glucagon levels. A: Glucose levels; B: Insulin levels; C: C-peptide levels; D: Glucagon levels.