Published online Dec 16, 2022. doi: 10.12998/wjcc.v10.i35.12946
Peer-review started: August 24, 2022
First decision: September 25, 2022
Revised: October 10, 2022
Accepted: November 22, 2022
Article in press: November 22, 2022
Published online: December 16, 2022
Processing time: 111 Days and 14 Hours
Pancreatic surgery for various disease processes (including both malignancy and benign disease) have been described for many years but only recently have techniques improved making certain metabolic consequences more known. De novo non-alcoholic fatty liver disease (NAFLD) has been associated with pancreatectomy after about 12 mo but risk factors are not well known given the heterogeneous populations that have been studied thus far.
Given the improvement in surgical techniques used for pancreatectomy, mortality has improved which has led to increased awareness of downstream metabolic effects. One of those effects, the development of de novo NAFLD, is especially interesting given the lack of traditional metabolic risk factors that are often associated with fatty liver disease. Therefore, there is more importance in defining risk factors that could lead to development of de novo NAFLD so that prevention and treatment can also be better defined.
To summarize the various per-operative risk factors that lead to development of de novo NAFLD after pancreatectomy along with potential management and treatment options.
A literature search from 2001 to 2022 was done and all study designs that investigated de novo NAFLD were included.
With an incidence rate up to 75%, de novo NAFLD can develop within 12 mo after pancreatectomy. Various risk factors have been established including pancreatic resection line and remnant pancreas volume, peri-operative malnutrition and weight loss, EPI, pancreatic endocrine insufficiency, malignancy as the indication for surgery, and postmenopausal status.
Since a majority of risk factors leads to exocrine pancreatic insufficiency and malnutrition, peri-operative focus on nutrition and enzymes replacement is key in preventing and treating de novo NAFLD after pancreatectomy.
Future studies should focus on per-operative management of nutrition including pancreatic enzyme replacement therapy while monitoring weight change and development, prevention, or improvement of de novo fatty liver disease.