Kosin Med J.  2022 Mar;37(1):68-74. 10.7180/kmj.22.008.

Hepatic steatosis changes after early gastric cancer surgery

• Kim KH
• Ock S
• Lee D
• Kim Y
• Jo J
• Seo K
• Yoon K
• Kwon S
• Choi Y
• Kim B

• KMID: 2527697
• DOI: http://doi.org/10.7180/kmj.22.008

Abstract

Background
Nonalcoholic fatty liver disease dramatically improves after bariatric surgery, primarily due to improvements in hepatic insulin sensitivity. Since the procedure for gastric cancer surgery is very similar to that for bariatric surgery, we investigated changes in fatty liver following gastrectomy for gastric cancer according to the type of surgery.
Methods
We evaluated hepatic steatosis in 212 early gastric cancer patients using Hounsfield units (HUs) on non-contrast computed tomography preoperatively and 6, 12, and 24 months after surgery. We compared the preoperative and postoperative liver-to-spleen HU ratio according to the type of surgery: Billroth I, Billroth II, and total gastrectomy with Roux-en-Y reconstruction.
Results
The initial results (liver/spleen HUs and the liver-to-spleen HU ratio) did not significantly differ according to surgical group. After surgery, only patients who underwent total gastrectomy with Roux-en-Y exhibited significant changes in the liver-to-spleen HU ratio at 6 months. In 26 patients who had higher initial HU levels of the spleen than the liver, the liver-to-spleen HU ratio significantly increased from 0.836 to 1.115 at 6 months, 1.109 at 12 months, and 1.102 at 24 months (P<0.01).
Conclusion
Significant changes in hepatic steatosis were found in even normal patients (with higher liver than spleen HU values) who underwent total gastrectomy with Roux-en-Y. Patients who initially had fatty liver also showed a significant increase in the liver-to-spleen HU ratio. These results suggest that total gastrectomy with Roux-en-Y reconstruction can have a positive effect on the improvement of hepatic steatosis.

Keyword

Hepatic steatosis; Liver disease; Stomach neoplasm

Figure

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  Fig. 1. Changes in the liver-to-spleen (LS) ratio according to type of surgery. a)p<0.05 compared to the preoperative values.

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  Fig. 2. Changes in the liver-to-spleen (LS) ratio among patients who had hepatic steatosis before surgery. a)p<0.05 compared to the preoperative values.

Reference

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