Change in liver fat content in patients following pancreatic resections

Metabolic sequelae of pancreatic resections, especially hepatic steatosis, has seldom been studied in detail. This study aims to examine the change in liver fat content following pancreatic resections, specifically pancreaticoduodenectomy, distal pancreatectomy and to identify potential predictors of post-pancreatectomy hepatic steatosis.

This prospective observational study was conducted from December 2022 to July 2024 and included patients who underwent pancreatic resections at a single tertiary care centre in southern India. Exclusion criteria included chronic liver disease and excessive alcohol consumption. Liver fat content was assessed using non-contrast computed tomography at baseline, six months and 12 months post-surgery. Liver fat was quantified using the liver attenuation index and liver attenuation in Hounsfield Units (HU). Liver fat content was defined as normal when liver attenuation index was more than + 5, mild to moderate (6% to 30%) when + 5 to -10 HU and severe (> 30%) when less than -10 HU.

Total 37 patients were included in this study (males:16, females: 21). Mean age was 50.4 years. Adenocarcinoma was the major etiology (43%) followed by neuroendocrine tumors (21.6%) and cystic neoplasms of pancreas (18.9%). Pre-operatively, 89.2% of patients had normal liver fat content. By six months post-surgery, 54% of patients had increased liver fat, with 20% exhibiting severe steatosis. At 12 months, 51.3% showed elevated liver fat. The increase in liver fat content was statistically significant (p-value = 0.00007). Patients undergoing pancreaticoduodenectomy had a higher incidence of hepatic steatosis at six months compared to those undergoing distal pancreatectomy (p-value = 0.019).

Post-pancreatectomy hepatic steatosis is common, particularly in patients undergoing pancreaticoduodenectomy. Metabolic dysfunction does not seem to be directly linked to factors such as diabetes, body mass index or chemotherapy. Further studies with larger cohorts and extended follow-up are needed to assess the long-term clinical significance of these changes, including progression to conditions such as non-alcoholic fatty liver disease.