Pathophysiology after pancreaticoduodenectomy

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.