title: Risk Factors for and Management of Postpancreatectomy Hepatic Steatosis.
abstract: BACKGROUND
  Relatively little is known about the risk factors and treatments for postpancreatectomy hepatic steatosis.
  
  
  METHODS
  The records of patients who underwent pancreaticoduodenectomy or total pancreatectomy between 2005 and 2010 and were followed up by periodic imaging were reviewed retrospectively. Risk factors and treatment for postpancreatectomy hepatic steatosis were analyzed.
  
  
  RESULTS
  A total of 253 patients were included in the analysis, including 137 males and 116 females, of median (5, 95 percentile) age 67 (47, 81) years. Of these 253 patients, 75 (29.6%) developed postpancreatectomy hepatic steatosis. Multivariable logistic regression analysis showed that female gender ( p = 0.005; odds ratio: 2.387; 95% confidence interval: 1.293-4.386), body mass index > 22.5 kg/m2( p = 0.007; odds ratio: 2.330; 95% confidence interval: 1.261-4.307), operative duration > 540 min ( p = 0.018; odds ratio: 2.286; 95% confidence interval: 1.153-4.533), and delayed gastric emptying ( p < 0.001; odds ratio: 4.598; 95% confidence interval: 1.979-10.678) were independent risk factors associated with postpancreatectomy hepatic steatosis. Treatment consisted of maintenance- or high-dose digestive enzyme replacement therapy. Of patients without obvious tumor recurrence after 6 months, 12 of 15 treated with high dose and only 6 of 35 treated with maintenance-dose digestive enzyme replacement therapy showed improvements in postpancreatectomy hepatic steatosis ( p = 0.006).
  
  
  CONCLUSIONS
  Female gender, obesity, longer operative time, and occurrence of delayed gastric emptying are risk factors for postpancreatectomy hepatic steatosis. High-dose digestive enzyme replacement therapy may improve postpancreatectomy hepatic steatosis.
authors.affiliation: 1 Department of Gastroenterological Surgery, Cancer Institute Ariake Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Takemura
authors.affiliation: 1 Department of Gastroenterological Surgery, Cancer Institute Ariake Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Saiura
authors.affiliation: 1 Department of Gastroenterological Surgery, Cancer Institute Ariake Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors.forename: R
authors.initials: R
authors.lastname: Koga
authors.affiliation: 2 Department of Surgery, National Defense Medical College, Saitama, Japan.
authors.forename: J
authors.initials: J
authors.lastname: Yamamoto
authors.affiliation: 1 Department of Gastroenterological Surgery, Cancer Institute Ariake Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Yamaguchi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005234:Fatty Liver / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Pancreaticoduodenectomy; digestive enzyme replacement therapy; postpancreatectomy hepatic steatosis