Incidence and clinical characteristics of hepatic steatosis following pancreatectomy

Abstract

Hepatic steatosis following pancreatic resection is a growing concern. Pancreatic enzyme replacement effectively treats the problem; however, the risks of hepatic steatosis remain unknown. In this study, we evaluated the risks of hepatic steatosis on 104 patients who underwent pancreatic surgery. Moreover, the effect of pancrelipase administration at 900mg/day, one of the pancreatic enzyme replacement therapies, on hepatic steatosis was evaluated. Twenty-one patients （20％） developed hepatic steatosis following pancreatic surgery. Low neutrophil-to-lymphocyte ratio （NLR）（p＝0.027） was identified as a risk factor for postoperative hepatic steatosis in the 104 participants following pancreatectomy. Particularly, in the 62 participants who underwent pancreaticoduodenectomy, younger age （p＝0.045）, lymphocyte-to-monocyte ratio （p＝0.029）, and lymph node metastasis （p＝0.026） were identified as risk factors for postoperative hepatic steatosis. Of the 10 patients with newly developed liver steatosis following pancreatoduodenectomy who could be evaluated, 6 improved with pancrelipase dose escalation, whereas 4 improved without escalation. In conclusion, this study suggested that immune-nutritional parameters including low NLR or high NMR can be closely associated with risk factors for hepatic steatosis following pancreatic surgery. Pancrelipase administration following pancreatic surgery may be optimal with doses starting at 900mg/day and increased when steatosis occurs.