Hepatic steatosis after pancreatectomy: Does duodenum preservation mitigate the risk?

Abstract

Abstract Background: Hepatic steatosis is a potential cause of long-term morbidity in 20-40% of post-pancreatectomy patients. Various risk factors have been proposed for hepatic steatosis after pancreatectomy. The present study aims to compare the incidence of post-pancreatectomy hepatic steatosis in patients with and without duodenum-preserving surgeries. Methods: A prospective cohort study of patients who underwent pancreatectomy with or without duodenum preservation for benign and malignant pancreatic diseases between January 2019 and December 2022 was included. Patients who underwent distal and total pancreatectomy were excluded. CT criteria for hepatic steatosis were absolute liver attenuation of less than 40 Hounsfield units (HU) or the difference between mean splenic and liver attenuation of more than 10 HU. Demographic parameters, exocrine insufficiency, and hepatic steatosis in post-operative periods were compared between the two groups. Results: 40 patients who underwent PD for malignant or non-malignant diseases were compared with 40 who underwent duodenal preserving pancreatic head resection (DPPHR) for chronic pancreatitis. Around 35% of patients had post-operative exocrine pancreatic enzyme insufficiency (EPI) in the DPPHR group, and 15% had EPI in the PD group. The incidence of hepatic steatosis after a minimum follow-up after six months was 17.5% (7/40) in the DPPHR group and 37.5% (15/40) in the PD group. Duodenal resection was found to be a significant risk factor for developing hepatic steatosis (P-0.045), which also persisted after propensity score matching analysis. Conclusion: Duodenal resection surgeries have more association with hepatic steatosis compared to duodenal preserving pancreatic surgeries.