One of the main causes of liver fat accumulation following pancreaticoduodenectomy is thought to be pancreatic exocrine insufficiency brought on by pancreatic atrophy. In light of the degree of residual pancreatic atrophy between reconstruction techniques (pancreaticogastrostomy vs. pancreaticojejunostomy (PJ)), this study was set to determine whether liver fat deposition was less common in patients who received combination therapy with high-titer pancreatic enzyme and zinc supplementation.
A retrospective evaluation was conducted on patients who had PD and periodic postoperative computed tomography (CT). The PG and PJ groups' remnant pancreatic volume and atrophy were compared using 3D reconstruction CT. A reduction of at least 0.10 in the liver-to-spleen attenuation ratio from postoperative day 7 to 3, 6, or 12 months was considered hepatic fat accumulation. Traditional and Bayesian logistic regression methods were used to evaluate the risk of hepatic fat accumulation after controlling for variables.
A total of 13 patients underwent combination treatment out of the 62 individuals (48 PJ, 14 PG) that were examined. Atrophy was more severe in PG than in PJ (median maximal atrophy rate: 0.37 [interquartile range: 0.24–0.54] vs. 0.23 [0.13–0.34], p = 0.037).
The combination therapy group (n = 13) had similar fat deposition rates (31% vs. 47%, p = 0.30), but a higher frequency of PG reconstruction (54% vs. 14%, p = 0.006) and a higher maximum pancreatic atrophy rate (0.35 [0.25–0.55] vs. 0.23 [0.13–0.34], p = 0.009). Combination treatment altered the impact of pancreatic atrophy on fat deposition, according to multivariate analysis (p for interaction = 0.066).
According to predicted probabilities, fat deposition rose from 79.0% (95% credible interval: 38.8–96.4%) at an atrophy rate of 0.15 to 92.7% (64.8–99.3%) at 0.45 in the absence of therapy, whereas probabilities dropped from 69.7% (20.0–96.5%) to 35.1% (6.0–75.6%) in the presence of therapy. At these atrophy levels, the associated odds ratios decreased from 0.62 to 0.04.
Overall, combination treatment with high-titer pancreatic enzyme and zinc supplementation may lower the likelihood of hepatic fat accumulation following PD in individuals with significant remaining pancreatic atrophy, which is frequently induced by PG.
Source:
Matsukuma, S., Kinjo, N., Suzuki, A., Nishio, Y., Yamamoto, N., Taura, Y., Tokuno, K., Sakano, H., Kawaoka, T., Akiyama, N., & Yamamoto, S. (2025). Postoperative supplementation with high-titer pancreatic enzymes and zinc acetate dihydrate could reduce the risk of liver fat deposition, especially in patients with severe remnant pancreatic atrophy after pancreaticoduodenectomy: a retrospective study. BMC Surgery, 25(1), 527. https://doi.org/10.1186/s12893-025-03268-y
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