Influence of pre-operative sarcopenia on post-operative hepatic steatosis after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma.

BACKGROUND

The relation between sarcopenia and hepatic steatosis is well established. However, to our knowledge, no study has explored this relationship in patients undergoing pancreatic surgery. The aim of this study is to determine whether pre-operative sarcopenia has an impact on hepatic density attenuation after pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC).

METHODS

In this retrospective cohort study, all patients who underwent PD in Lille University Hospital between 2011 and 2020 were included. Pre-operative sarcopenia was assessed using Skeletal Muscle Index (SMI) measurements, cut-offs for the sarcopenic group were 38.9 cm/m for women and 55.4 cm/m for men. Hepatic steatosis was defined as a mean hepatic density <40 Hounsfield units (HU). We measured liver density on pre- and post-operative CT scans at 1, 6 months and after 6 months. Liver density attenuation was compared between sarcopenic and non-sarcopenic groups.

RESULTS

One hundred and nine patients were included. Sixty-six patients (61%) were diagnosed with pre-operative sarcopenia and 39 (36%) presented post-operative hepatic steatosis within the first 6 months. No significant difference was shown between the two groups in terms of liver density attenuation before and after surgery (P=0.97). In the multivariate analysis, lower age [odds ratio (OR): 0.57, 95% confidence interval (CI): 0.36-0.89, P=0.01] and higher body mass index (BMI) (OR: 1.61, 95% CI: 1.02-2.57, P=0.04) were risk factors for hepatic steatosis after PD for PDAC. Pre-operative sarcopenia and post-operative hepatic steatosis within the first 6 months had no impact on 3 years survival.

CONCLUSIONS

Pre-operative sarcopenia had no significant impact on liver density attenuation before and after surgery. Lower age and higher BMI are associated with post-PD hepatic steatosis in patients with PDAC. Prospective studies should be considered to clarify these results.