Influence of pre-operative sarcopenia on post-operative hepatic steatosis after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma
Original Article

Influence of pre-operative sarcopenia on post-operative hepatic steatosis after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma

Louis Caputo1, Yasmina Richa2 ORCID logo, Kaja Balcer1, César Beugniez1, Mathilde Vermersch3, Julien Bourry4, Emeline Cailliau5, Stephanie Truant1, Mehdi El Amrani1

1Department of Digestive Surgery and Transplantation, Lille University Hospital, Lille, France; 2School of Medicine, University College Cork, Cork, Ireland; 3Department of Radiology, Valenciennes Hospital, Valenciennes, France; 4Department of Nutrition, Lille University Hospital, Lille, France; 5Department of Biostatistics, Lille University Hospital, Lille, France

Contributions: (I) Conception and design: M El Amrani, L Caputo; (II) Administrative support: M El Amrani, L Caputo; (III) Provision of study materials or patients: M El Amrani, L Caputo; (IV) Collection and assembly of data: L Caputo; (V) Data analysis and interpretation: E Cailliau, M El Amrani, L Caputo; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

Correspondence to: Mehdi El Amrani, MD, PhD. Department of Digestive Surgery and Transplantation, Lille University Hospital, Michel Polonovski Road, 59037 Lille, France. Email: mehdi_elamrani@hotmail.fr.

Background: The relation between sarcopenia and hepatic steatosis is well established. However, to our knowledge, no study has explored this relationship in patients undergoing pancreatic surgery. The aim of this study is to determine whether pre-operative sarcopenia has an impact on hepatic density attenuation after pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC).

Methods: In this retrospective cohort study, all patients who underwent PD in Lille University Hospital between 2011 and 2020 were included. Pre-operative sarcopenia was assessed using Skeletal Muscle Index (SMI) measurements, cut-offs for the sarcopenic group were 38.9 cm2/m2 for women and 55.4 cm2/m2 for men. Hepatic steatosis was defined as a mean hepatic density <40 Hounsfield units (HU). We measured liver density on pre- and post-operative CT scans at 1, 6 months and after 6 months. Liver density attenuation was compared between sarcopenic and non-sarcopenic groups.

Results: One hundred and nine patients were included. Sixty-six patients (61%) were diagnosed with pre-operative sarcopenia and 39 (36%) presented post-operative hepatic steatosis within the first 6 months. No significant difference was shown between the two groups in terms of liver density attenuation before and after surgery (P=0.97). In the multivariate analysis, lower age [odds ratio (OR): 0.57, 95% confidence interval (CI): 0.36–0.89, P=0.01] and higher body mass index (BMI) (OR: 1.61, 95% CI: 1.02–2.57, P=0.04) were risk factors for hepatic steatosis after PD for PDAC. Pre-operative sarcopenia and post-operative hepatic steatosis within the first 6 months had no impact on 3 years survival.

Conclusions: Pre-operative sarcopenia had no significant impact on liver density attenuation before and after surgery. Lower age and higher BMI are associated with post-PD hepatic steatosis in patients with PDAC. Prospective studies should be considered to clarify these results.

Keywords: Pancreatic ductal adenocarcinoma (PDAC); sarcopenia; hepatic steatosis; pancreaticoduodenectomy (PD); nationwide database

Submitted Sep 17, 2024. Accepted for publication Mar 27, 2025. Published online Jun 24, 2025.

doi: 10.21037/jgo-24-700

Highlight box

Key findings

• Pre-operative sarcopenia had no significant impact on liver density attenuation.

What is known and what is new?

• The relation between sarcopenia and hepatic steatosis is well established.

• Pre-operative sarcopenia had no significant impact on liver density attenuation before and after pancreatic surgery.

What is the implication, and what should change now?

• Lower age and higher body mass index are associated with post-pancreaticoduodenectomy hepatic steatosis in patients with pancreatic ductal adenocarcinoma and should be considered when evaluating patients at risk of hepatic steatosis.

Introduction

Background

Non-alcoholic fatty liver disease (NAFLD) is the leading cause of chronic hepatopathy in France, with a prevalence of approximately 18% (1). It can lead to non-alcoholic steatohepatitis (NASH), characterized by inflammation, and in extreme cases to cirrhosis and hepatocarcinoma. Given its prevalence and complications, NAFLD represents a major public health concern and warrants attention for prevention and management. Pancreatic ductal adenocarcinoma (PDAC) is a growing concern, with incidence rates rising by 1.5 % for men and 2.1% for women each year in France (2). It is now the 6th cancer-related cause of death worldwide, despite being the 12th most common cancer globally (3). Pancreaticoduodenectomy (PD) remains the only curative surgical option for PDAC of the pancreatic head. PD has been associated with de novo post-operative NAFLD, in part due to exocrine and endocrine pancreatic insufficiency (4-7). A higher pre-operative body mass index (BMI) has also been shown to be a risk factor for post-operative hepatic steatosis (8). The European Working Group on Sarcopenia in Older People (EWGSOP) has defined sarcopenia as a “progressive and general loss of skeletal muscle mass and strength, causing adverse effects such as a poor quality of life, physical insufficiency and higher mortality”. Sarcopenia is highly prevalent amongst oncology patients (9). Although numerous studies have demonstrated the link between sarcopenia and NAFLD, primarily through mechanisms such as chronic systemic inflammation or insulin deficiency, the causal relationship between the two remains uncertain (10-12).

Rationale and knowledge gap

To our knowledge, this is the first study focusing on this relationship in patients undergoing PD for PDAC.

Objective

The primary objective of this study is to determine whether pre-operative sarcopenia had an impact on liver density attenuation within first 6 months after PD for PDAC. The secondary objectives were: (I) to identify pre-operative risk factors for hepatic steatosis; and (II) to evaluate the impact of sarcopenia and liver steatosis on survival after PD for PDAC. We present this article in accordance with the STROBE reporting checklist (available at https://jgo.amegroups.com/article/view/10.21037/jgo-24-700/rc).

Methods

Study population

All patients who underwent PD for PDAC between 2011 and 2020 in Lille University Hospital in France were retrospectively included. Inclusion criteria included: age ≥18 years, open approach, and curative resection. Exclusion criteria consisted of: PD for other diagnoses than PDAC, other pancreatic resections, palliative derivation without resection, age <18 years, and the lack of data. The study complied with French National Health guidelines on research involving human subjects. The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments, and has been approved by the ethics board of Lille University Hospital (No. DEC24-086). The patients’ consent was not collectible given the retrospective interventional design. A derogation has been obtained.

Data collection

Preoperative clinical data were collected including age, sex, comorbidities according to Charlson comorbidity index (CCI) [stratified into two groups (CCI =0–2 and CCI ≥3)], American Society of Anesthesiologists (ASA) score, nutritional markers (albumin, pre-albumin, preoperative weight, weight loss between healthy weight and preoperative weight, undernutrition grade) and biliary drainage before surgery. Complications at 3 months postoperatively were collected and rated according to the Clavien-Dindo classification (13), with severe complications defined by a grade ≥3. Postoperative pancreatic fistula was defined according to the International Study Group of Pancreatic Fistula (ISGPF) and classified into grades B or C (14). Bleeding and postoperative gastroparesis were graded according to the international consensus (15), and length of stay (LOS) was also assessed. Operative mortality was defined as death within 90 days of PD. The living status of all patients was verified using the Institut National de Statistiques et des Etudes Economiques (INSEE) database (16).

Outcome measurements

Sarcopenia was measured using the Skeletal Muscle Index (SMI), which consists of the entire muscle surface on a L2–3 computed tomography (CT) scan cross-section (Figure 1), in cm2, divided by the square height of the patient in m2. To define sarcopenia, we used the cut-offs reported by Mourtzakis et al. of 38.9 cm2/m2 for women and 55.4 cm2/m2 for men (17). Hepatic steatosis was measured using a mean of 5 regions of interest (ROI) in the liver parenchyma, on a non-injected CT scan section (Figure 2). A measure below the cut-off of 40 Hounsfield units (HU) was used to define hepatic steatosis (18). Preoperative SMI and hepatic steatosis were assessed on the most recent preoperative CT scan using the MYRIAN software and were measured within 6 months after PD and after 6 months.

Figure 1 Total muscular surface on a L2–3 CT section. CT, computed tomography.
Figure 2 Example of an ROI in the liver parenchyma on a non-injected CT section. CT, computed tomography; HU, Hounsfield unit; ROI, regions of interest; SD, standard deviation.

Statistical analysis

Qualitative variables were described in terms of frequencies and percentages. Quantitative variables were described by the mean and standard deviation or by the median and interquartile range in cases of non-Gaussian distribution. The normality of the distributions was graphically checked and using the Shapiro-Wilk test. Patient survival was estimated using the Kaplan-Meier method. Patient characteristics and preoperative data were compared between patients with sarcopenia and those without using the Chi-squared test (or Fisher’s exact test when the expected count was <5) for qualitative variables, and using the Student’s t-test (or Mann-Whitney U test in cases of non-Gaussian distribution) for quantitative variables. The association between sarcopenia status and the change in liver density 6 months postoperatively was analysed using a mixed linear model (covariance pattern, with a compound symmetry covariance matrix) on liver density values, including a time effect in the model (6 months vs. preoperative), sarcopenia status, and the interaction term between sarcopenia status and time. The mean difference in liver density variation 6 months postoperatively according to sarcopenia status was estimated from the interaction term. The model was adjusted for sex and preoperative liver density (including an interaction term with time). The normality of the model’s residuals was verified. The association between sarcopenia status and different postoperative criteria was assessed using a logistic regression model for binary outcomes, a one-way analysis of variance (ANOVA) for quantitative outcomes, and a Cox proportional hazards model for survival. Effect sizes and their 95% confidence intervals (CIs) were derived from the models [odds ratios (ORs) for binary outcomes, mean differences for quantitative outcomes, and hazard ratios for survival]. A sensitivity analysis adjusted for sex, CCI (categorized: 0+1+2 vs. 3+4 vs. >4), age, and BMI was performed for the primary outcome of liver density. The identification of risk factors for hepatic steatosis within 6 months postoperatively was conducted using univariate and multivariate logistic regression models. ORs and their 95% CIs were derived from the models as a measure of effect size. Factors with a P value <0.20 in the univariate analysis were included in the multivariate logistic regression model. The association between hepatic steatosis within 6 months postoperatively and patient survival was assessed using a Cox proportional hazards model, with the origin date set as the date 6 months postoperatively (landmark at 6 months). The association between preoperative SMI and patient survival was also assessed using a Cox proportional hazards model. Hazard ratios and their 95% CIs were derived from both models as a measure of effect size. We designed a scatter plot to study the correlation between 1–6 months SMI and liver density. No statistical comparison was made for qualitative variables with a sample size <8. The significance level was set at 5%. Statistical analyses were performed using the SAS software (SAS Institute version 9.4).

Results

A total of 185 patients who underwent PD for PDAC were identified. After exclusion of patients with missing data (n=71), unclear pathological diagnosis (n=2), extended resection (n=2) and another tumor localization (n=1), 109 patients were included.

Patient characteristics

Demographic data are detailed in Table 1. The mean age of patients was 64.5 years, with a majority being male. With regards to comorbidities, 60 patients (55%) had a CCI ≥3. Overall, 61% of patients had sarcopenia and the mean pre-operative SMI was 46.48 cm2/m2. Hepatic steatosis was present in 36% of patients at 1–6 months.

Table 1

Patient characteristics

Variable N All patients Sarcopenia
No (n=43) Yes (n=66) P value
Age (years) 109 64.5±9.7 66.8±8 63.1±10.4 0.045
Sex ratio (M/F) 109 1.27 0.65 2 0.005
ASA score 2.09±0.67
   ASA 1–2 109 84 [77] 32 [74] 52 [79] 0.6
   ASA 3–4 109 25 [23] 11 [26] 14 [21]
Charlson score 109 2.84±2.58
   0–2 49 [45] 13 [30] 36 [55] 0.01
   ≥3 60 [55] 30 [70] 30 [45]
Comorbidities
   High blood pressure 108 42 [39] 21 [49] 21 [32] 0.059
   Ischemic heart disease 108 13 [12] 4 [9] 9 [14] 0.52
   Heart failure 108 2 [2] 1 [2] 1 [2]
   Kidney failure 108 2 [2] 2 [5] 0 [0]
   COPD 109 5 [5] 4 [9] 1 [2]
   Chronic pancreatitis 109 5 [5] 2 [5] 3 [5]
   Diabetes 109 31 [28] 12 [28] 19 [29] 0.92
   Cirrhosis 102 1 [1] 1 [2] 0 [0]
Nutritional markers
   Albumin (g/L) 104 37.37±5.43 37.83±5.25 37.08±5.56 0.49
   Pre-albumin (g/L) 79 0.2±0.07 0.2±0.06 0.2±0.07 0.98
   Pre-operative BMI (kg/m2) 109 25.32±4.93 27.02±5.52 24.22±4.19 0.006
SMI (cm2/m2)
   Pre-operative 108 46.48±10.71 53.45±10.23 41.86±8.3 <0.001
   1–6 months 109 34.61±6.92 36.74±7.67 33.23±6.04
   >6 months 88 36.57±7.76 37.58±8.24 35.87±6.86
Liver density (HU)
   1–6 months 109 38.16±23.79 37.77±23.69 38.41±24.03
   >6 months 89 41.14±25.47 43.63±24.32 39.46±26.32
Hepatic steatosis
   Pre-operative 108 11 [10] 3 [7] 8 [12] 0.52
   1–6 months 108 39 [36] 13 [30] 26 [39]
   >6 months 89 26 [29] 9 [21] 17 [32]
Post operative complications
   Clavien-Dindo ≥3 109 20 [18] 10 [23] 10 [15]
Anatomopathology 0.42
   pT1–2 106 48 [45] 17 [40] 31 [47]
   pT3–4 106 58 [55] 25 [60] 33 [50]
Chemotherapy
   Neoadjuvant chemotherapy 109 36 [33] 15 [35] 21 [32]
   Adjuvant chemotherapy 107 94 [88] 33 [77] 61 [92]
Death
   1 year 109 16 [15] 6 [14] 10 [15]
   3 years 109 69 [63] 30 [70] 39 [59]

Data are presented as n [%] or mean ± SD unless otherwise specified. ASA, American Society of Anesthesiologists; BMI, body mass index; COPD, chronic obstructive pulmonary disease; F, female; HU, Hounsfield unit; M, male; SD, standard deviation; SMI, skeletal muscle index.

Comparison between sarcopenic and non-sarcopenic patients

Non-sarcopenic patients were significantly older (66.8 vs. 63.1 years, P=0.045) and had a significantly lower male to female ratio (M/F) (0.65 vs. 2, P=0.005) compared to sarcopenic patients. Regarding comorbidities, there were more patients in the non-sarcopenic group with a CCI ≥3 (P=0.01). Moreover, the pre-operative BMI was significantly higher (P=0.006) in the non-sarcopenic group (27.02 kg/m2) compared to the sarcopenic group (24.22 kg/m2) (Table 1).

Correlation between sarcopenia and hepatic steatosis

No significant difference (P=0.97) was found between non-sarcopenic and sarcopenic patients regarding liver density attenuation after PD for PDAC after adjusting the analysis for patient’s sex. The mean preoperative liver density was 52.98 HU in the non-sarcopenic group and 52.04 HU in the sarcopenic group. Liver density decreased to 37.77 in non-sarcopenic patients and 38.40 in sarcopenic patients after surgery (Figures 3,4). This result was similar after adjusting for sex, CCI, age and preoperative BMI (P=0.20). Preoperative sarcopenia did not impact hepatic steatosis after 6 months (OR 1.42, 95% CI: 0.55–3.67, P=0.52), administration of adjuvant chemotherapy (OR 2.96, 95% CI: 0.89–9.77, P=0.07), and Clavien-Dindo 3 and 4 complications (OR 0.59, 95% CI: 0.22–1.56, P=0.29).

Figure 3 Scatter plot of pre-operatives SMI (cm2/m2) and liver density (HU). HU, Hounsfield unit; SMI, skeletal muscle index.
Figure 4 Scatter plot of 1–6 months SMI (cm2/m2) and liver density (HU). HU, Hounsfield unit; SMI, skeletal muscle index.

Risk factors for hepatic steatosis after PD for PDAC

We performed a univariate and multivariate analysis to assess for risk factors of hepatic steatosis within 6 months after PD (Tables 2,3). In the univariate analysis, a lower age was significantly associated with the occurrence of hepatic steatosis. As shown in Table 2, increased age was significantly associated with decreased liver steatosis after PD for PDAC (OR 0.57, P=0.01, 95% CI: 0.37–0.84). This tendency was confirmed in the multivariate analysis (Table 3). Additionally, the multivariate analysis showed that preoperative BMI was significantly associated with postoperative liver steatosis (OR 1.62, P=0.04, 95% CI: 1.02–2.57).

Table 2

Univariate analysis of predictive factors for hepatic steatosis at 1–6 months

Variable OR 95% CI P value
Denutrition Grade 1 0.91 0.36–2.32 0.84
Denutrition Grade 2 0.73 0.25–2.10 0.84
Pre-operative biliary drainage 1.44 0.64–3.24 0.38
Neo-adjuvant chemotherapy 0.50 0.20–1.21 0.12
Age 0.57 0.37–0.84 0.01
Pre-operative BMI 1.43 0.94–2.16 0.08
Pre-operative albumin level 0.96 0.64–1.43 0.84
Pre-operative prealbumin level 1.04 0.63–1.70 0.88

BMI, body mass index; CI, confidence interval; OR, odds ratio.

Table 3

Multivariate analysis of predictive factors for hepatic steatosis at 1–6 months

Variable OR 95% CI P value
Neoadjuvant chemotherapy 0.58 0.22–1.53 0.27
Age 0.57 0.36–0.89 0.01
Pre-operative BMI 1.62 1.02–2.57 0.04

BMI, body mass index; CI, confidence interval; OR, odds ratio.

Impact of sarcopenia and hepatic steatosis on survival after PD for PDAC

No significant difference was shown between non-sarcopenic and sarcopenic patients in terms of 3-year survival (P=0.54). Furthermore, hepatic steatosis within 6 months after PD for PDAC had no impact on survival (P=0.90).

Discussion

To our knowledge, this study is the first to assess the correlation between preoperative sarcopenia and postoperative hepatic steatosis in the context of pancreatic surgery. Similarly to previous studies, 36.1% of patients had hepatic steatosis (19) and 61% had sarcopenia (20). Our analysis showed no significant difference in terms of hepatic density attenuation between non-sarcopenic and sarcopenic patients (P=0.97), while previous studies reported a correlation between sarcopenia and NAFLD (11). This could be explained by the fact that physiological and physical changes induced by PD may mask the effects of pre-operative sarcopenia on hepatic steatosis. Physiological mechanisms of sarcopenia and hepatic steatosis should be further explored to determine the risk factors for these two conditions.

Our results revealed no significant difference in 3 years survival between non-sarcopenic and sarcopenic or between steatosis and no steatosis groups (Figures 5,6). Previous research has suggested a poorer prognosis for patients with postoperative hepatic steatosis or pre-operative sarcopenia (20,21). Our results could be explained by a limited sample size, resulting in insufficient statistical power. Conducting a multicentric study could help to address this limitation and provide more robust conclusions on the survival outcomes.

Figure 5 Survival curve for preoperative sarcopenia.
Figure 6 Survival curve for hepatic steatosis.

Similarly to previous studies, our multivariate analysis revealed that BMI was significantly higher in patients with post-operative steatosis. Patel et al. (4) showed, in an analysis of 136 patients, an OR of 1.19 (95% CI: 1.02–1.4, P=0.03) for the occurrence of hepatic steatosis following PD. BMI was also an independent risk factor for hepatic steatosis after total PD in Kato et al.’s study (8), a retrospective multicentric study of 148 patients. Similarly, Sato et al. found a significantly higher BMI in 120 patients with steatosis after PD (22). The multivariate analysis also showed that decreasing age was significantly associated with the occurrence of post-operative steatosis after PD for PDAC. To our knowledge, no study has previously reported this postoperative finding. A higher age is considered as a risk factor for the occurrence of hepatic steatosis after pancreatectomy in previous publications (23). Further research is needed to elucidate this correlation.

The present study has some limitations. First, the retrospective nature may be a source of potential bias. Second, data about exocrine and endocrine pancreatic insufficiencies were not available, although they may contribute in the occurrence of liver steatosis (8,19,21,24). Third, the definition of sarcopenia and liver steatosis was only focused on imaging data, making these measures very restrictive. Indeed, other methods to measure muscle mass such as BMI or dual energy X-ray absorptiometry (DXA), are more precise, but given the retrospective nature of this study and the lack of access to this data, we chose to use SMI to measure muscle mass. Other strategies, such as MRI or liver biopsy, could be considered (19,25). Finally, all patients in this study were treated in the same center, which limits the external validity of our findings.

Conclusions

No correlation was found between pre-operative sarcopenia and liver density attenuation after PD for PDAC. Further investigations are needed to clarify these findings, and a prospective multicentric study would be beneficial to standardize data collection and enhance the robustness of these results.

Acknowledgments

None.

Footnote

Reporting Checklist: The authors have completed the STROBE reporting checklist. Available at https://jgo.amegroups.com/article/view/10.21037/jgo-24-700/rc

Data Sharing Statement: Available at https://jgo.amegroups.com/article/view/10.21037/jgo-24-700/dss

Peer Review File: Available at https://jgo.amegroups.com/article/view/10.21037/jgo-24-700/prf

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jgo.amegroups.com/article/view/10.21037/jgo-24-700/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments, and has been approved by the ethics board of Lille University Hospital (No. DEC24-086). The patients’ consent was not collectible given the retrospective interventional design. A derogation has been obtained.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

  1. Estes C, Anstee QM, Arias-Loste MT, et al. Modeling NAFLD disease burden in China, France, Germany, Italy, Japan, Spain, United Kingdom, and United States for the period 2016-2030. J Hepatol 2018;69:896-904. [Crossref] [PubMed]
  2. Drouillard A, Manfredi S, Lepage C, et al. Epidemiology of pancreatic cancer. Bull Cancer 2018;105:63-9. [Crossref] [PubMed]
  3. 13-pancreas-fact-sheet.pdf. [cité 25 août 2024]. Disponible sur: https://gco.iarc.who.int/media/globocan/factsheets/cancers/13-pancreas-fact-sheet.pdf
  4. Patel V, Shah P, Ludwig DR, et al. Development of de novo nonalcoholic fatty liver disease following pancreatectomy. Medicine (Baltimore) 2023;102:e32782. [Crossref] [PubMed]
  5. Olefson S, Jackson M, Grand DJ, et al. Identification of Nonalcoholic Fatty Liver Disease following Pancreatic Surgery in a Western Cohort Using a Novel Radiographic Technique. J Clin Transl Hepatol 2015;3:246-53. [Crossref] [PubMed]
  6. Luu C, Thapa R, Rose T, et al. Identification of nonalcoholic fatty liver disease following pancreatectomy for noninvasive intraductal papillary mucinous neoplasm. Int J Surg 2018;58:46-9. [Crossref] [PubMed]
  7. Li Z, Weinstein J, Redstone E, et al. Hepatic Steatosis After Partial Pancreatectomy in a Cohort of Patients with Intraductal Papillary Mucinous Neoplasm. J Clin Exp Hepatol 2023;13:955-61. [Crossref] [PubMed]
  8. Kato H, Kamei K, Suto H, et al. Incidence and risk factors of nonalcoholic fatty liver disease after total pancreatectomy: A first multicenter prospective study in Japan. J Hepatobiliary Pancreat Sci 2022;29:428-38. [Crossref] [PubMed]
  9. Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 2019;48:16-31. Erratum in: Age Ageing 2019;48:601. [Crossref] [PubMed]
  10. Hong HC, Hwang SY, Choi HY, et al. Relationship between sarcopenia and nonalcoholic fatty liver disease: the Korean Sarcopenic Obesity Study. Hepatology 2014;59:1772-8. [Crossref] [PubMed]
  11. Li AA, Kim D, Ahmed A. Association of Sarcopenia and NAFLD: An Overview. Clin Liver Dis (Hoboken) 2020;16:73-6. [Crossref] [PubMed]
  12. Joo SK, Kim W. Interaction between sarcopenia and nonalcoholic fatty liver disease. Clin Mol Hepatol 2023;29:S68-78. [Crossref] [PubMed]
  13. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205-13. [Crossref] [PubMed]
  14. Bassi C, Marchegiani G, Dervenis C, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After. Surgery 2017;161:584-91. [Crossref] [PubMed]
  15. Wente MN, Bassi C, Dervenis C, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 2007;142:761-8. [Crossref] [PubMed]
  16. arbre.app. [cité 15 juin 2024]. Fichier des décès de l’Insee. Available online: https://arbre.app/insee
  17. Mourtzakis M, Prado CM, Lieffers JR, et al. A practical and precise approach to quantification of body composition in cancer patients using computed tomography images acquired during routine care. Appl Physiol Nutr Metab 2008;33:997-1006. [Crossref] [PubMed]
  18. Xiao Y, Xiao-Yue Z, Yue W, et al. Use of computed tomography for the diagnosis of surgical sarcopenia: Review of recent research advances. Nutr Clin Pract 2022;37:583-93. [Crossref] [PubMed]
  19. Shah P, Patel V, Ashkar M. De novo non-alcoholic fatty liver disease after pancreatectomy: A systematic review. World J Clin Cases 2022;10:12946-58. [Crossref] [PubMed]
  20. El Amrani M, Vermersch M, Fulbert M, et al. Impact of sarcopenia on outcomes of patients undergoing pancreatectomy: A retrospective analysis of 107 patients. Medicine (Baltimore) 2018;97:e12076. [Crossref] [PubMed]
  21. Okamura Y, Sugimoto H, Yamada S, et al. Risk factors for hepatic steatosis after pancreatectomy: a retrospective observational cohort study of the importance of nutritional management. Pancreas 2012;41:1067-72. [Crossref] [PubMed]
  22. Sato T, Matsuo Y, Shiga K, et al. Factors that predict the occurrence of and recovery from non-alcoholic fatty liver disease after pancreatoduodenectomy. Surgery 2016;160:318-30. [Crossref] [PubMed]
  23. Ivanics T, Sanjeevi S, Ansorge C, et al. Hepatic Steatosis Following Pancreatic Surgery: A Swedish Centers Experience with Demographics, Risks and Outcome. J Pancreas 2015;16:527-32.
  24. Nakagawa N, Murakami Y, Uemura K, et al. Nonalcoholic fatty liver disease after pancreatoduodenectomy is closely associated with postoperative pancreatic exocrine insufficiency. J Surg Oncol 2014;110:720-6. [Crossref] [PubMed]
  25. Starekova J, Hernando D, Pickhardt PJ, et al. Quantification of Liver Fat Content with CT and MRI: State of the Art. Radiology 2021;301:250-62. [Crossref] [PubMed]
Cite this article as: Caputo L, Richa Y, Balcer K, Beugniez C, Vermersch M, Bourry J, Cailliau E, Truant S, El Amrani M. Influence of pre-operative sarcopenia on post-operative hepatic steatosis after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma. J Gastrointest Oncol 2025;16(3):1305-1313. doi: 10.21037/jgo-24-700

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