Hepatic Steatosis After Partial Pancreatectomy in a Cohort of Patients with Intraductal Papillary Mucinous Neoplasm

Abstract

Background/aims: Nonalcoholic fatty liver disease (NAFLD) has been observed in patients after partial pancreatectomy. Previous studies have been performed on oncologic patients who underwent partial pancreatectomy and received adjuvant chemotherapy. By studying a cohort of patients with intraductal papillary mucinous neoplasms (IPMNs) who did not receive chemotherapy, the authors investigate the isolated effect of partial pancreatectomy on the development of fatty liver.

Methods: A retrospective search for patients with pancreatic IPMNs who underwent partial pancreatectomy at an academic center from 2006 to 2014 identified 63 patients, including 42 who had pancreaticoduodenectomy (PD) and 21 who had distal pancreatectomy (DP). Fourteen patients with preoperative hepatic steatosis, diabetes, obesity, on steroid therapy, history of malignancy, or incomplete data were excluded. No patient received chemotherapy. Liver fat signal fraction (LFSF) was computed by the Dixon method using pre- and postoperative in- and out-of-phase MRI.

Results: Of the 49 patients included in the study, 29 (59%) underwent PD and 20 (41%) underwent DP. A total of 17 patients (34%) developed fatty liver after surgery. The entire cohort developed significant weight loss, 72.1 versus 69.4 kg (P < 0.01). Postoperatively, there was significant increase in LFSF, 1.3% versus 9.6% following PD (P < 0.01), and 2.1% versus 9.4% following DP (P = 0.01).

Conclusion: Partial pancreatectomy increases the risk of NAFLD independent of chemotherapy-induced hepatotoxicity. The underlying mechanism remains unclear and possibly related to pancreatic exocrine insufficiency and malnutrition.

Keywords: IPMN; hepatic steatosis; partial pancreatectomy.

Graphical abstract

Figure 1

Patient selection.

Figure 2

T1-weighted in-phase (A, B, C) and out-of-phase (D, E, F) images: This is an example of a patient who developed mild hepatic steatosis with liver fat fraction of 8% one year out from pancreaticoduodenectomy (B, E) and 11% after 2 years (C, F). The circles on the images denote the 4 regions of interest used in liver fat fraction computation.

Figure 3

Comparison of varying degree of hepatic steatosis after partial pancreatectomy: pancreaticoduodenectomy vs. distal pancreatectomy. Note that significant proportion of patients developed fatty liver after the operation. Interestingly, the surgical approach, PD or DP, does not affect the outcome of hepatic steatosis.