Pancreatic enzyme replacement therapy for prevention of postpancreatectomy hepatic steatosis after pancreatoduodenectomy: a post hoc analysis of a randomized placebo-controlled trial.

内容摘要

Postpancreatectomy hepatic steatosis (PHS) is a long-term complication after pancreaticoduodenectomy (PD). We investigated the association between PERT and the development of PHS. Among patients randomized to PERT or placebo after PD in a previous prospective study (NCT02127021), 94 patients with preoperative and 1-year postoperative unenhanced computed tomography (CT) were included. PHS was defined as liver attenuation of <40 Hounsfield units (HU) or liver-to-spleen attenuation difference of &#x2265;10 HU on non-contrast CT. The PERT group contained 42 patients and the placebo group contained 52 patients. The incidence of PHS at 1 year was significantly lower in the PERT group compared with the placebo group (9.5% vs. 23.1%, p < 0.001). Independent risk factors in the multivariable analysis were placebo intake (OR 2.376, p < 0.001) and body weight loss of >5% at 3 months postoperatively (OR 1.602, p = 0.046). Subgroup analysis confirmed that PERT consistently reduced the incidence of PHS in patient with body weight loss of >5% after 3 months of medication administration. PERT was associated with a significantly lower incidence of PHS after PD than placebo, with sustained benefits in patients with significant postoperative body weight loss.