Nonalcoholic fatty liver disease following laparoscopic duodenum-preserving pancreatic total head resection vs laparoscopic pancreaticoduodenectomy: A retrospective cohort study

doi:10.3748/wjg.v31.i13.104046

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World Journal of Gastroenterology

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Retrospective Cohort Study

World J Gastroenterol. Apr 7, 2025; 31(13): 104046
Published online Apr 7, 2025. doi: 10.3748/wjg.v31.i13.104046

Table 1 Postoperative laboratory and imaging variables of patients with non-alcoholic fatty liver disease or not, n (%)

Variables	Overall (n = 59)	NAFLD group (n = 17)	Not NAFLD group (n = 42)	P value
Surgical procedures				0.022
LPD	35 (59.3)	14 (40.0)	21 (60.0)
LDPPHRt	24 (40.7)	3 (12.5)	21 (87.5)
Until postoperative 1 month
Postoperative bleeding	7 (11.9)	4 (23.5)	3 (7.1)	0.176
DGE	20 (33.9)	5 (29.4)	15 (35.7)	0.643
POPF	13 (22.0)	2 (11.8)	11 (26.2)	0.388
SSI	1 (1.7)	1 (5.9)	0	0.288
Postoperative within 6-12 months
AST (U/L)	23 [17, 32]	27 [21, 37]	23 [17, 32]	0.167
ALT (U/L)	23 [13, 46]	23 [15, 49]	25 [13, 45]	0.657
AST/ALT	1.1 [0.8, 1.5]	1.3 [0.9, 1.5]	1.1 [0.7, 1.4]	0.284
FIB-4 index	1.3 [0.8, 1.9]	1.4 [0.8, 1.9]	1.1 [0.8, 1.9]	0.514
Albumin (g/L)	41.1 [37.2, 45.3]	40.5 [35.2, 43.9]	41.1 [37.5, 45.5]	0.307
Total cholesterol (mmol/L)	3.7 [3.2, 4.3]	3.9 [2.8, 4.5]	3.7 [3.3, 4.1]	0.821
Random blood glucose(mmol/L)	5.6 [5.1, 6.5]	6.0 [5.1, 9.5]	5.6 [5.1, 6.0]	0.312
TBIL (μmol/L)	10.5 [8.0, 15.0]	11.0 [8.3, 14.5]	10.2 [7.9, 15.0]	0.633
NFS index	-2.2 [-3.5, -1.3]	-2.1 [-3.7, -0.9]	-2.3 [-3.5, -1.5]	0.493
ALP (U/L)	87 [70, 129]	101 [79, 195]	86 [69, 118]	0.128

ALP: Alkaline phosphatase; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; DGE: Delayed gastric emptying; FIB-4: Fibrosis-4; LDPPHRt: Laparoscopic duodenum-preserving total pancreatic head resection; LPD: Laparoscopic pancreaticoduodenectomy; NAFLD: Nonalcoholic fatty liver disease; POPF: Postoperative pancreatic fistula; SSI: Surgical site infection; TBIL: Total bilirubin; NFS: Nonalcoholic fatty liver disease fibrosis score.

Table 2 Baseline characteristics of patients undergoing laparoscopic pancreaticoduodenectomy and laparoscopic duodenum-preserving total pancreatic head resection, n (%)

Variables	Overall (n = 59)	LPD group (n = 35)	LDPPHRt group (n = 24)	P value
Sex				0.628
Male	20 (33.9)	11 (31.4)	9 (37.5)
Female	39 (66.1)	24 (68.6)	15 (62.5)
Age (year)	53 (40, 63)	56 (46, 63)	52 (35, 61)	0.407
Weight (kg)	57.1 ± 9.8	59.00 ± 10.38	54.4 ± 8.4	0.078
BMI (kg/m²)	21.3 ± 2.9	21.9 ± 3.2	20.4 ± 2.2	0.042
Abdominal surgery history	23 (39.0)	12 (34.3)	11 (45.8)	0.372
ASA classification				0.181
I	2 (3.4)	1 (2.9)	1 (4.2)
II	34 (57.6)	17 (48.6)	17 (70.8)
III	23 (39.0)	17 (48.6)	6 (25.0)
Consistency of pancreas				0.334
Soft	41 (69.5)	26 (74.3)	15 (62.5)
Firm or hard	18 (30.5)	9 (25.7)	9 (37.5)
AST (U/L)	17 [14.0, 22.0]	17 [14.0, 25.0]	16 [14.0, 19.75]	0.104
ALT (U/L)	13 [10.0, 25.0]	13 [11.0, 38.0]	11.5 [9.25, 19.25]	0.042
AST/ALT	1.3 [0.9, 2.0]	1.3 [0.7, 1.5]	1.4 [1.1, 1.6]	0.083
FIB-4 index	1.2 [0.7, 1.8]	1.3 [0.8, 1.8]	1.1 [0.7, 1.8]	0.396
TC (mmol/L)	3.89 [3.44, 4.49]	3.95 [3.44, 4.50]	3.86 [3.38, 4.32]	0.611
TG (mmol/L)	0.96 [0.71, 1.40]	0.96 [0.71, 1.57]	0.97 [0.67, 1.37]	0.835
Albumin (g/L)	40.5 ± 3.3	40.0 ± 3.2	41.4 ± 3.3	0.077
Random blood glucose (mmol/L)	5.1 [4.7, 5.7]	5.4 [4.8, 6.2]	5.0 [4.5, 5.5]	0.071
Uric acid (μmol/L)	286 [250, 357]	300 [250, 364]	271 [249, 323]	0.343
Liver-to-spleen CT attenuation differential (HU)	3.8 [2.2, 7.9]	3.8 [2.3, 7.9]	3.4 [1.4, 7.9]	0.502
Liver-to-spleen CT attenuation ratio	1.03 [1.02, 1.06]	1.03 [1.02, 1.05]	1.02 [1.01, 1.06]	0.422

ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; BMI: Body mass index; CT: Computed tomography; FIB-4: Fibrosis-4; HU: Hounsfield unit; LDPPHRt: Laparoscopic duodenum-preserving total pancreatic head resection; LPD: Laparoscopic pancreaticoduodenectomy; TC: Total cholesterol; TG: Triglycerides.

Table 3 Intra- and postoperative characteristics of patients undergoing laparoscopic pancreaticoduodenectomy and laparoscopic duodenum-preserving total pancreatic head resection, n (%)

Variables	Overall (n = 59)	LPD group (n = 35)	LDPPHRt group (n = 24)	P value
Operative time (min)	310 [270, 346]	312 [270, 360]	309 [291, 329]	0.616
Blood loss (mL)	100 [50, 200]	100 [50, 149]	125 [50, 200]	0.426
Days of hospitalization (day)	27 [23, 40]	27 [24, 43]	27 [21, 38]	0.378
Postoperative pathology				< 0.001
IPMN	15 (25.4)	6 (17.1)	9 (37.5)
SCA	12 (20.3)	2 (5.7)	10 (41.7)
SPN	3 (5.1)	2 (5.7)	1 (4.2)
PNEN	7 (11.9)	5 (14.3)	2 (8.3)
Chronic pancreatitis	9 (15.3)	9 (25.7)	0
Others	13 (22.0)	11 (31.4)	2 (8.3)
Until postoperative 1 month
Postoperative bleeding	7 (11.9)	3 (8.6)	2 (8.3)	1.000
DGE	20 (33.9)	7 (20.0)	13 (54.2)	0.006
POPF	13 (22.0)	6 (17.1)	10 (41.7)	0.037
SSI	1 (1.7)	0	1 (4.2)	0.407
ERT	28 (47.5)	15 (42.9)	13 (54.2)	0.393

DGE: Delayed gastric emptying; ERT: Enzyme replacement therapy; IPMN: Intraductal papillary mucinous neoplasm; LDPPHRt: Laparoscopic duodenum-preserving total pancreatic head resection; LPD: Laparoscopic pancreaticoduodenectomy; POPF: Postoperative pancreatic fistula; SSI: Surgical site infection; PNEN: Pancreatic neuroendocrine neoplasm; SCA: Serous cystadenoma; SPN: Solid pseudopapillary neoplasm.

Table 4 Postoperative laboratory and imaging variables of patients undergoing laparoscopic pancreaticoduodenectomy and laparoscopic duodenum-preserving total pancreatic head resection, n (%)

Variables	Overall (n = 59)	LPD group (n = 35)	LDPPHRt group (n = 24)	P value
Postoperative within 6-12 months
Weight (kg)	55.17 ± 8.53	55.81 ± 8.69	54.24 ± 8.37	0.492
AST (U/L)	23 [17, 32]	27 [20, 42]	21 [16, 27]	0.022
ALT (U/L)	23 [13, 46]	28 [12, 47]	22 [13, 40]	0.346
AST/ALT	1.1 [0.8, 1.5]	1.1 [0.9, 1.5]	1.2 [0.7, 1.4]	0.459
FIB-4 index	1.3 [0.8, 1.9]	1.4 [0.8, 2.2]	0.8 [0.7, 1.6]	0.020
Albumin (g/L)	40.5 ± 3.3	40.5 ± 6.0	41.2 ± 6.0	0.645
Total cholesterol (mmol/L)	3.7 [3.2, 4.3]	3.8 [3.4, 4.4]	3.5 [3.2, 4.1]	0.203
Random blood glucose(mmol/L)	5.6 [5.1, 6.5]	5.7 [5.2, 6.6]	5.6 [4.9, 6.7]	0.534
TBIL (μmol/L)	10.5 [8.0, 15.0]	11.0 [8.7, 15.0]	9.0 [6.8, 14.5]	0.316
NFS index	-2.2 [-3.5, -1.3]	-2.0 [-3.0, -1.0]	-2.8 [-3.9, -1.8]	0.050
ALP (U/L)	87 [70.0, 129.0]	95.0 [78.0, 192.0]	84.5 [58.5, 97.0]	0.035
de novo NAFLD	17 (28.8)	14 (40.0)	3 (12.5)	0.022
Liver-to-spleen CT attenuation differential (HU)	5.0 [-3.3, 11.5]	1.7 [-8.0, 9.0]	9.4 [4.1, 14.3]	0.018
Liver-to-spleen CT attenuation ratio	1.0 [1.0, 1.1]	1.0 [0.9, 1.1]	1.1 [1.0, 1.1]	0.030

ALP: Alkaline phosphatase; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; CT: Computed tomography; FIB-4: Fibrosis-4; GGT: Gamma-glutamyl transferase; HU: Hounsfield unit; LDPPHRt: Laparoscopic duodenum-preserving total pancreatic head resection; LPD: Laparoscopic Pancreaticoduodenectomy; NAFLD: Nonalcoholic fatty liver disease; TBIL: Total bilirubin; NFS: Nonalcoholic fatty liver disease fibrosis score.

Table 5 Univariate analysis of the risk factors for nonalcoholic fatty liver disease

Factor	Univariate analysis
Factor	OR (95%CI)	P value
Sex
Male	1.091 (0.334-3.563)	0.885
Female	Reference
Age
≥ 60 years	2.222 (0.694-7.118)	0.179
< 60 years	Reference
BMI
Abnormal (preoperative BMI, ≥ 25 kg/m²)	1.586 (0.334-7.530)	0.562
Normal	Reference
Consistency of pancreas
Soft	2.593 (0.641-10.488)	0.182
Firm or hard	Reference
Preoperative TC	1.538 (0.845-2.799)	0.159
Preoperative TG	5.896 (1.702-20.425)	0.005
Operation time	1.005 (0.995-1.014)	0.338
Blood loss	1.000 (0.994-1.006)	0.975
Postoperative variables
AST/ALT	1.443 (0.549-3.789)	0.457
FIB-4 index	1.271 (0.905-1.784)	0.167
Albumin	0.927 (0.840-1.024)	0.135
Total cholesterol	1.223 (0.775-1.931)	0.387
Random blood glucose	1.317 (0.948-1.830)	0.101
NFS index	1.205 (0.851-1.707)	0.293
Postoperative bleeding	0.577 (0.088-3.802)	0.568
DGE	0.917 (0.281-2.944)	0.885
POPF	3.705 (0.750-18.739)	0.107
Days of hospitalization (day)	1.023 (0.986-1.062)	0.228
Surgical procedures	1.023 (0.986-1.062)	0.228
LDPPHRt	0.214 (0.054-0.857)	0.029
LPD	Reference

ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; BMI: Body mass index; CI: Confidence intervals; DGE: Delayed gastric emptying; FIB-4: Fibrosis-4; LDPPHRt: Laparoscopic duodenum-preserving total pancreatic head resection; LPD: Laparoscopic pancreaticoduodenectomy; POPF: Postoperative pancreatic fistula; TC: Total cholesterol; TG: Triglycerides; OR: Odds ratio; NFS: Nonalcoholic fatty liver disease fibrosis score.

Table 6 Multivariate analysis of the risk factors for nonalcoholic fatty liver disease

Factor	Multivariate analysis
Factor	OR (95%CI)	P value
Surgical procedures
LDPPHRt	0.208 (0.046-0.931)	0.040
LPD	Reference
Preoperative TG	6.251 (1.656-23.591)	0.007

CI: Confidence intervals; LDPPHRt: Laparoscopic duodenum-preserving total pancreatic head resection; LPD: Laparoscopic pancreaticoduodenectomy; TG: Triglycerides; OR: Odds ratio.

Citation: Zhen TT, Li SZ, Pan ST, Yin TY, Wang M, Guo XJ, Zhang H, Qin RY. Nonalcoholic fatty liver disease following laparoscopic duodenum-preserving pancreatic total head resection vs laparoscopic pancreaticoduodenectomy: A retrospective cohort study. World J Gastroenterol 2025; 31(13): 104046
URL: https://www.wjgnet.com/1007-9327/full/v31/i13/104046.htm
DOI: https://dx.doi.org/10.3748/wjg.v31.i13.104046