HEPATIC STEATOSIS AFTER NEOADJUVANT CHEMOTHERAPY FOR PANCREATIC CANCER: INCIDENCE AND IMPLICATIONS FOR OUTCOMES AFTER PANCREATODUODENECTOMY
Mohammed Al-Temimi*, Katelyn Flick, Christopher Sublette, Jordan swensson, Attila Nakeeb, Eugene P. Ceppa, Trang K. Nguyen, Nicholas J. Zyromski, Christian Schmidt, Mark Tann, Michael G. House
General Surgery, Indiana University, Indianapolis, IN
Background: Neoadjuvant chemotherapy is utilized with increasing frequency for patients with resectable pancreatic adenocarcinoma. The aim of this study was to determine the incidence of moderate/severe hepatic steatosis after neoadjuvant chemotherapy and its potential impact on operative outcomes after pancreatoduodenectomy.
Methods: Patients who received neoadjuvant chemotherapy for pancreatic adenocarcinoma and underwent pancreatoduodenectomy at a single institution between 2014 and 2017 were analyzed. Radiographic hepatic steatosis was defined as liver attenuation that is lower than 10 Hounsfield units (HU) less than that of the spleen on non-contrast CTs or lower than 20 HU less than that of the spleen on post-contrast CTs. Moderate and severe steatosis was evaluated qualitatively. Patients with moderate/severe hepatic steatosis prior to treatment were excluded. Operative outcomes were compared between patient groups according to the degree of hepatic steatosis development (moderate/severe vs. mild/none) during neoadjuvant chemotherapy.
Results: A total of 149 patients with pancreatic adenocarcinoma received neoadjuvant chemotherapy for a median of 5 cycles (IQR=4-6). FOLFIRINOX was the chemotherapy regimen in 78% of patients. Moderate/severe Hepatic steatosis developed in 36 (24%) patients after neoadjuvant chemotherapy. The median time from completion of chemotherapy to operation was 40 days (IQR=29-51 days). Preoperative biliary stenting and radiation therapy were used in 126 (85%) and 25 (17%) patients, respectively. Vascular resection was performed in 26% of cases. Patients with moderate/severe chemotherapy-associated hepatic steatosis were more likely to be obese, female, and have longer exposure to chemotherapy (mean, 85 days vs. 63 days, p=0.011), Table 1. Radiographic pancreatic steatosis and pancreatic gland texture at the time of operation were not associated with chemotherapy-associated hepatic steatosis. No objective findings of portal hypertension were found in patients with steatosis. On bivariate and multivariate logistic regression analysis, mortality (8% vs. 2%, p=0.08), major morbidity (11% vs. 15%, p=0.60) and overall morbidity (16% vs. 29%, p=0.14) were not different between the hepatic steatosis and non-steatosis groups. Pancreatectomy-specific outcomes, including postoperative pancreatic fistula (8% vs. 4%, p=0.29) and DGE (8% vs. 14%, p=0.41), did not differ between the two groups.
Conclusion:
Moderate/severe hepatic steatosis develops in 24% of patients who receive neoadjuvant chemotherapy for pancreatic adenocarcinoma but does not appear to be associated with increased morbidity or mortality after pancreatoduodenectomy.
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