title: Perioperative Computed Tomography Assessments of the Pancreas Predict Nonalcoholic Fatty Liver Disease After Pancreaticoduodenectomy.
abstract: Nonalcoholic fatty liver disease (NAFLD) after pancreaticoduodenectomy (PD) has become a clinically important issue. Although pancreatic exocrine insufficiency has been reported to be a main cause of NAFLD after PD, a clinically practical examination to assess the pancreatic exocrine function has not been established. The aim of this study was to evaluate risk factors for NAFLD after PD with a focus on perioperative computed tomography (CT) assessments of the pancreas.A retrospective review of 245 patients followed for more than 6 months after PD was conducted. We evaluated several pancreatic CT parameters, including the pancreatic parenchymal thickness, pancreatic duct-to-parenchymal ratio, pancreatic attenuation, and remnant pancreatic volume (RPV) on pre- and/or postoperative CT around 6 months after surgery. The variables, including the pancreatic CT parameters, were compared between the groups with and without NAFLD after PD.The incidence of NAFLD after PD was 19.2%. A multivariate analysis identified 5 independent risk factors for NAFLD after PD: a female gender (odds ratio [OR] 5.66, P < 0.001), RPV < 12 mL (OR 4.73, P = 0.001), preoperative pancreatic attenuation of <30 Hounsfield units (OR 4.50, P = 0.002), dissection of the right-sided nerve plexus around the superior mesenteric artery (OR 3.02, P = 0.017) and a preoperative serum carbohydrate antigen 19-9 level of ≥70 U/mL (OR 2.58, P = 0.029).Our results showed that 2 pancreatic CT parameters, the degree of preoperative pancreatic attenuation and RPV, significantly influence the development of NAFLD after PD. Perioperative CT assessments of the pancreas may be helpful for predicting NAFLD after PD.
authors.affiliation: From the Division of Hepato-Biliary-Pancreatic Surgery (KO, YO, YY, RA, TI, TS, KU) and Division of Interventional Radiology (TA), Shizuoka Cancer Center, Shizuoka, Japan.
authors.forename: Katsuhisa
authors.initials: K
authors.lastname: Ohgi
authors.forename: Yukiyasu
authors.initials: Y
authors.lastname: Okamura
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Yamamoto
authors.forename: Ryo
authors.initials: R
authors.lastname: Ashida
authors.forename: Takaaki
authors.initials: T
authors.lastname: Ito
authors.forename: Teiichi
authors.initials: T
authors.lastname: Sugiura
authors.forename: Takeshi
authors.initials: T
authors.lastname: Aramaki
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Uesaka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D017063:Outcome Assessment, Health Care; D010179:Pancreas / Q000000981:diagnostic imaging* / Q000601:surgery; D016577:Pancreaticoduodenectomy; D019990:Perioperative Care; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed