RISK FACTORS OF DEVELOPING NONALCOHOLIC FATTY LIVER DISEASE FOLLOWING PANCREATIC RESECTION: A SYSTEMATIC REVIEW AND META-ANALYSIS
Kavin Sugumar*, Lora Naik, Jonathan J. Hue, Luke Rothermel, Lee M. Ocuin, John Ammori, Jeffrey Hardacre, Jordan M. Winter
University Hospitals, Cleveland, OH
Introduction: Nonalcoholic fatty liver disease occurs in 10-40% of patients following pancreatic resection. We perform a comprehensive systematic review and meta-analysis to better understand the risk factors of hepatic steatosis and illustrate all the possible mechanisms of NAFLD.
Methods: A systematic literature search was performed in MEDLINE, Scopus, and Cochrane Library in November 2020. Studies focused on the risk factors associated with NAFLD in post pancreatic resection patients were included. The Odds ratio (OR) denoting the association of the various risk factors with NAFLD post resection was curated from the included articles.
Results: Of the 563 published articles, 16 studies met inclusion criteria. All were retrospective observational cohort studies. Combined, these studies included clinical data on 2494 patients. The incidence of NAFLD in the studies ranged from 7% to 46%. Among the various risk factors analyzed, the following had a higher likelihood of NAFLD on forest plot analysis: female gender (OR: 2.36), pancreatic ductal adenocarcinoma (OR: 2.25), portal vein or superior mesenteric vein resection (OR: 2.53), dissection of nerve plexus around the superior mesenteric artery (OR: 1.93), postoperative pancreatic endocrine insufficiency (OR: 3.15), and adjuvant chemotherapy (OR: 1.59). Due to heterogeneity of included studies, the effect of exocrine insufficiency on NAFLD could not be studied. Based on our results and previously published studies, the possible mechanisms of NAFLD are shown in Figure 1.
Conclusion: Numerous factors are associated with the incidence of NAFLD. Further studies focusing on pancreatic enzyme supplementation and exocrine insufficiency are needed.
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