Identification of nonalcoholic fatty liver disease following pancreatectomy for noninvasive intraductal papillary mucinous neoplasm

Objective: To assess metabolic dysfunctions and steatohepatosis after standard and local pancreatic resections for benign and premalignant neoplasms. Summary of Background Data: Duodenopancreatectomy, hemipancreatectomy, and parenchyma-sparing, limited pancreatic resections are currently in use for nonmalignant tumors. Methods: Medline, Embase, and Cochrane libraries were searched for studies reporting measured data of metabolic functions following PD, pancreatic left resection (PLR), duodenum-sparing pancreatic head resection (DPPHR), pancreatic middle segment resection (PMSR), and tumor enucleation (TEN). Forty cohort studies comprising data of 2729 patients were eligible.Results: PD for benign tumor was associated in 46 of 327 patients (14.1%) with postoperative new onset of diabetes mellitus (pNODM) and in 109 of 243 patients (44.9%) with postoperative new onset of pancreatic exocrine insufficiency measured after a mean follow-up of 32 months. The meta-analysis displayed pNODM following PD in 32 of 204 patients (15.7%) and in 10 of 200 patients (5%) after DPPHR [P < 0.01; OR: 0.33; (95%-CI: 0.15-0.22)]. PEI was found in 77 of 174 patients following PD (44.3%) and in 7 of 104 patients (6.7%) following DPPHR (P < 0.01;OR: 0.15; 95%-CI: 0.07-0.32). pNODM following PLR was reported in 107 of 459 patients (23.3%) and following PMSR 23 of 412 patients (5.6%) (P < 0.01; OR: 0.20; 95%-CI: 0.12-0.32). Postoperative new onset of pancreatic exocrine insufficiency was found in 17% following PLR and in 8% following PMSR (P < 0.01). pNODM following PPPD and tumor enucleation was observed in 19.7% and 5.7% (P < 0.03) of patients, respectively. Following PD/PPPD, 145 of 608 patients (23.8%) developed a nonalcoholic fatty liver disease after a mean follow-up of 30.4 months. Steatohepatosis following DPPHR developed in 2 of 66 (3%) significantly lower than following PPPD (P < 0.01). Conclusion: Standard pancreatic resections for benign tumor carry a considerable high risk for a new onset of diabetes, pancreatic exocrine insufficiency and following PD for steatohepatosis. Parenchyma-sparing, local resections are associated with low grade metabolic dysfunctions.

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“…The mean age was 64.7 (SD AE 5.9) years, the sex relation M/F 1:0.8. Three studies 59,62,63 exclusively included patients with a benign tumor.…”

Section: Results Of Baseline Datamentioning

confidence: 99%

“…However, the first diagnosis of NAFLD was made during the first postoperative year in most patients. Three studies 59,62,63 reported development of NAFLD in 17.4% of patients with benign tumor, who underwent PD/PPPD exclusively. Studies with PD for predominantly malignant tumors reported NAFLD in 23.7% of patients.…”

Section: Nonalcoholic Fatty Liver Diseasementioning

confidence: 99%

Long-term Metabolic Morbidity and Steatohepatosis Following Standard Pancreatic Resections and Parenchyma-sparing, Local Extirpations for Benign Tumor

et al. 2021

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“…Given that the cause of NAFLD is malnutrition, the lower incidence of NAFLD after DPPHR could be explained by the preservation of the duodenal and bile duct in the DPPHR group, thus preserving postoperative nutrition by maintaining normal gastroduodenal function and physiological bile secretion. Lue et al 26 revealed that the incidence of NAFLD is significantly lower in DP than in PD, even though the amount of resection of the pancreatic parenchyma is greater in DP than in PD. The absence of gastrointestinal reconstruction and preservation of the duodenum in DP may be essential for the low incidence of NAFLD.…”

Section: Discussionmentioning

confidence: 99%

Significant positive impact of duodenum‐preserving pancreatic head resection on the prevention of postoperative nonalcoholic fatty liver disease and acute cholangitis

Kato

Asano

Ito

et al. 2022

Annals of Gastroent Surgery

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Aim: This study aimed to compare the incidence of postoperative nonalcoholic fatty liver disease (NAFLD), postoperative cholangitis, and fibrosis-4 (FIB)-4 index in patients who underwent duodenum-preserving pancreatic head resection (DPPHR) and pancreaticoduodenectomy (PD) for low-grade malignant tumors and verify the usefulness of DPPHR in preventing the occurrence of these disorders. Methods: This retrospective study included 70 patients who underwent PD (n = 39) and DPPHR (n = 31) between 2006 and 2018 for benign or low-grade malignant tumors. The present study compared the preoperative background, cumulative incidence of postoperative NAFLD and cholangitis, and other biochemical markers, including the FIB-4 index. Subanalysis by propensity score matching (PSM) analysis was conducted to minimize treatment selection bias.Results: In terms of the cumulative incidence of NAFLD, the 5-y incidence was significantly lower in the DPPHR group than in the PD group both before (10% vs 38%, P = .002) and after (13% vs 38%, P = .008) matching. Multivariate analyses identified DPPHR as the only independent preventive factor for postoperative NAFLD (hazard ratio: 0.160, 95% confidence intervals: 0.034-0.76, P = .021). The 5-y cumulative incidence of postoperative cholangitis was significantly higher in the PD group than in the DPPHR group before (51% vs 3%, P < .001) and after (49% vs 4%, P < .001) matching.The FIB-4 index at 12 mo postoperatively was significantly better in the DPPHR group than in the PD group (1.45 vs 2.35, P = .006) before matching. Conclusion:Preservation of the duodenum and bile duct may contribute to preventing long-term postoperative NAFLD and cholangitis, and liver fibrosis for benign or low-grade malignant pancreatic head tumors. K E Y W O R D S duodenum-preserving pancreatic head resection, FIB-4 index, pancreaticoduodenectomyThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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“…Luu et al showed that patients who underwent pancreatectomy for benign noninvasive intraductal papillary mucinous neoplasms had a lower risk of developing NAFLD compared with patients with malignant disease. PD and the development of pancreatic atrophy were identified as significant risk factors in this study [ 51 ]. A small retrospective cohort study found that newly emerging NAFLD only developed occasionally after pancreatic neuroendocrine tumor resection and was mainly observed in patients with recurrent diseases.…”

Section: Nafld Following Pancreatoduodenectomymentioning

confidence: 99%

Mechanisms of nonalcoholic fatty liver disease and implications for surgery

Kaufmann

Reca

Wang

et al. 2020

Langenbecks Arch Surg

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Background Nonalcoholic fatty liver disease (NAFLD) has become the most common form of chronic liver disease in both adults and children worldwide. Understanding the pathogenic mechanisms behind NAFLD provides the basis for identifying risk factors, such as metabolic syndrome, pancreatoduodenectomy, and host genetics, that lead to the onset and progression of the disease. The progression from steatosis to more severe forms, such as steatohepatitis, fibrosis, and cirrhosis, leads to an increased number of liver and non-liver complications. Purpose NAFLD-associated end-stage liver disease (ESLD) and hepatocellular carcinoma (HCC) often require surgery as the only curative treatment. In particular, the presence of NAFLD together with the coexisting metabolic comorbidities that usually occur in these patients requires careful preoperative diagnosis and peri-/postoperative management. Bariatric surgery, liver resection, and liver transplantation (LT) have shown favorable results for weight loss, HCC, and ESLD in patients with NAFLD. The LT demand and the increasing spread of NAFLD in the donor pool reinforce the already existing lack of donor organs. Conclusion In this review, we will discuss the diverse mechanisms underlying NAFLD, its implications for surgery, and the challenges for patient management.

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Identification of nonalcoholic fatty liver disease following pancreatectomy for noninvasive intraductal papillary mucinous neoplasm

Cited by 13 publications

References 20 publications

Long-term Metabolic Morbidity and Steatohepatosis Following Standard Pancreatic Resections and Parenchyma-sparing, Local Extirpations for Benign Tumor

Long-term Metabolic Morbidity and Steatohepatosis Following Standard Pancreatic Resections and Parenchyma-sparing, Local Extirpations for Benign Tumor

Significant positive impact of duodenum‐preserving pancreatic head resection on the prevention of postoperative nonalcoholic fatty liver disease and acute cholangitis

Mechanisms of nonalcoholic fatty liver disease and implications for surgery

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