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The Impact of CT-Assessed Liver Steatosis on Postoperative Complications After Pancreaticoduodenectomy for Cancer

  • Pancreatic Tumors
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Abstract

Introduction

Liver steatosis (LS) has been increasingly described in preoperative imaging of patients undergoing pancreaticoduodenectomy (PD). The aim of this study was to assess the impact of preoperative LS on complications after PD and identify possible contributors to LS development in this specific cohort.

Methods

Pancreatic head adenocarcinoma (PDAC) patients scheduled for PD, with preoperative CT-imaging available were included in the study. LS was defined as mean liver density lower than 45 Hounsfield units. Patients showing preoperative LS were matched for patient age, gender, BMI, ASA score, neoadjuvant treatment, and vascular and multivisceral resections, based on propensity scores in a 1:2 ratio to patients with no LS. The primary outcome was postoperative complication severity at 90 days as measured by the comprehensive complication index (CCI)

Results

Overall, 247 patients were included in the study. Forty-three (17%) patients presented with LS at preoperative CT-scan. After matching, the LS group included 37 patients, whereas the non-LS group had 74 patients. LS patients had a higher mean (SD) CCI, 29.7 (24.5) versus 19.5 (22.5), p = 0.035, and a longer length of hospital stay, median [IQR] 12 [8–26] versus 8 [7–13] days, p = 0.006 compared with non-LS patients. On multivariate analysis, variables independently associated with CCI were: LS (16% increase, p = 0.048), male sex (19% increase, p = 0.030), ASA score ≥ 3 (26% increase, p = 0.002), fistula risk score (FRS) (28% increase for each point of FRS, p = 0.001) and vascular resection (20% increase, p = 0.019).

Conclusion

Preliminary evidence suggests that preoperative LS assessed by CT-scan influences complication severity in patients undergoing PD for PDAC.

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Acknowledgments

The authors are grateful to Fondazione Umberto Veronesi for supporting Dr. Guarneri’s research fellowship. The authors are grateful to Dr. Alice Wong Licinio for her English language review and editing.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Giovanni Guarneri’s research fellowship, unrelated to this study, was funded by Fondazione Umberto Veronesi.

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Author notes

  1. Giovanni Guarneri and Diego Palumbo share the first authorship.

Authors and Affiliations

  1. Division of Pancreatic Surgery, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy

    Giovanni Guarneri MD, Nicolò Pecorelli MD, MSc, Domenico Tamburrino MD, PhD, Stefano Partelli MD, PhD, Stefano Crippa MD, PhD & Massimo Falconi MD

  2. Vita-Salute San Raffaele University, Milan, Italy

    Giovanni Guarneri MD, Diego Palumbo MD, Nicolò Pecorelli MD, MSc, Francesco Prato MD, Chiara Gritti MD, Raffaele Cerchione MD, Stefano Partelli MD, PhD, Stefano Crippa MD, PhD, Michele Reni MD, Francesco De Cobelli MD & Massimo Falconi MD

  3. Department of Radiology, San Raffaele Scientific Institute, Milan, Italy

    Diego Palumbo MD & Francesco De Cobelli MD

  4. Department of Medical Oncology, San Raffaele Scientific Institute, Milan, Italy

    Michele Reni MD

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  1. Giovanni Guarneri MD
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Correspondence to Nicolò Pecorelli MD, MSc.

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Supplementary file 1 (DOCX 17 KB)

10434_2022_11946_MOESM2_ESM.tif

Supplementary Disease free survival (DFS) in patients with preoperative LS and in those without preoperative LS. Median DFS was 20 months for patients without preoperative LS compared with 14 months of those with preoperative LS (p=0.147) (TIF 157 KB)

Supplementary Absolute standardized differences in means in the cohort before and after matching (TIF 167 KB)

Supplementary R-graphs for absolute standardized balance of different covariates before and after matching (TIF 168 KB)

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Guarneri, G., Palumbo, D., Pecorelli, N. et al. The Impact of CT-Assessed Liver Steatosis on Postoperative Complications After Pancreaticoduodenectomy for Cancer. Ann Surg Oncol 29, 7063–7073 (2022). https://doi.org/10.1245/s10434-022-11946-x

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