Effect of pancreaticoduodenectomy on the course of hepatic steatosis

Background The progression of hepatic steatosis after pancreaticoduodenectomy (PD) is controversial. This study was designed to determine whether PD would influence the course of hepatic steatosis. Methods Patients admitted for PD and distal pancreatectomy (DP) from January 2004 to January 2008 were enrolled. Exclusion criteria included liver metastasis, severe obesity (body mass index[30), diabetic mellitus, excessive alcohol consumption, and unavailable preoperative and 6-month postoperative unenhanced CT images. The pre-PD and post-PD liver attenuation, ratio, and difference of liver-to-spleen attenuation between liver and spleen attenuation were compared. Results Fifty patients who underwent PD and 20 patients who underwent DP were eligible. The mean follow-up period was 18.2 ± 1.6 months for the PD group and 19.7 ± 1.7 months for the DP group. Liver attenuation after PD was significantly decreased from 52.3 ± 1.1 H. to 47.6 ± 2 H. (p = 0.044), but no difference was observed in spleen attenuation. The liver-to-spleen attenuation ratio after PD also was significantly decreased: 1.12 ± 0.02 versus 1.01 ± 0.04 (p = 0.033). No difference in liver attenuation was found in the DP group. The female gender was a significant risk factor. Conclusions The liver attenuation of CT images decreases in patients who receive PD, which implicates that hepatic steatosis can develop after PD; however, the mechanism needs to be elucidated.