Table 4.
Recent clinical studies about fatty liver after pancreaticoduodenectomy
| Ref. | Year | Patient number | Follow-up period | Definitions of NAFLD | Incidence of fatty liver, n (%) | Risk factors/observation |
| (mo) | ||||||
| Song et al[90] | 2011 | 228 | 16 | When CTS-L was equal to or less than 10 HU When CTL/S was equal to or less than 0.9 HU | 15 (7.8) | In multivariate analysis, Pancreatic fistula (HR = 3.332, P = 0.037) External pancreatic duct stent (HR = 4.530, P = 0.017) |
| Sato et al[91] | 2014 | 110 | 6 | Hepatic CT value of less than 40 HU | 44 (40) | In multivariate analysis, |
| Younger age (OR = 1.079, P = 0.002), Female (OR = 6.102, P < 0.001) | ||||||
| Small remnant pancreatic volume (< 10 mL), OR = 4.109, P = 0.009 | ||||||
| Suspicion infection on POD7-28 (OR = 3.109, P = 0.027) | ||||||
| Kato et al[92] | 2010 | 54 | 7.7 ± 2.1 | Hepatic CT value of less than 40 HU a | 20 (37.0) | In multivariate analysis, |
| Pancreatic adenocarcinoma (P < 0.05) | ||||||
| Pancreatic resection line (left side of SMA, SMA/PV) (P < 0.01) | ||||||
| Diarrhea (P < 0.05) | ||||||
| Nagai et al[71] | 2014 | 361 | 6 | When CTL/S was equal to or less than 0.9 HU | 30 (8.3) | In patients with NAFLD, CTL/S ratio was significantly improved by pancrelipase treatment |
| Nutritional status by total protein, albumin, and cholesterol was significantly improved by pancrelipase treatment | ||||||
| Severe diarrhea was improved | ||||||
| Malnutrition after PD might be cause for postoperative NAFLD | ||||||
| Ito et al[93] | 2014 | 100 | NA | When CTL/S was equal to or less than 0.9 HU | 12 (12) | In multivariate analysis, Blood loss (HR = 1.001, P = 0.016) |
| Nakagawa et al[94] | 2014 | 104 | Median 7.7 (2.5-23.6) | When CTS-L was equal to or less than 10 HU | 26 (25) | In multivariate analysis, Postoperative pancreatic exocrine insufficiency (HR = 4.16, P = 0.02) |
| Tanaka et al[72] | 2011 | 60 | 12 | When CTL/S was equal to or less than 0.9 HU When CTL/S was equal to or less than 0.9 HU | 14 (23) | In multivariate analysis, |
| Pancreatic head cancer (OR = 12.0, P = 0.006) | ||||||
| De novo NAFLD after PD was associated with body weight loss and decreases in serum levels of albumin, cholinesterase, and total cholesterol | ||||||
| After administration of pancreatic enzyme, body weight and serum concentrations of albumin, cholinesterase, and total cholesterol were markedly increased | ||||||
| In addition, hepatic steatosis and serum AST and ALT levels were also significantly improved by treatment | ||||||
| De novo NAFLD after PD was primarily | ||||||
| caused by pancreatic exocrine insufficiency |
NAFLD: Non-alcoholic fatty liver disease; NA: Not available; AST: Aspartate transaminase; PD: Pancreaticoduodenectomy.