Risk factors for nonalcoholic fatty liver disease after gastrectomy for gastric cancer
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ORIGINAL ARTICLE
Risk factors for nonalcoholic fatty liver disease after gastrectomy for gastric cancer Keita Kouzu1 · Hironori Tsujimoto1 · Makoto Nishikawa1 · Manabu Harada1 · Takao Sugihara1 · Hiromi Nagata1 · Shuichi Hiraki1 · Yoshihisa Yaguchi1 · Risa Takahata1 · Shinsuke Nomura1 · Nozomi Ito1 · Yusuke Ishibashi1 · Yujiro Itazaki1 · Satoshi Tsuchiya1 · Kazuo Hase1 · Yoji Kishi1 · Hideki Ueno1 Received: 15 June 2019 / Accepted: 11 September 2019 © The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2019
Abstract Background Nonalcoholic fatty liver disease (NAFLD) refers to hepatic steatosis caused by something other than alcoholic liver injury, and often occurs after gastrointestinal surgeries such as pancreatoduodenectomy and gastrectomy. This study aimed to identify the risk factors for NAFLD after gastrectomy for gastric cancer. Methods A total of 721 patients who underwent gastrectomy for gastric cancer and plane abdominal computed tomography (CT) preoperatively and 1 year after surgery were included in this study. NAFLD was defined as having a mean hepatic CT attenuation value of 20 g of alcohol per day for females. Patients’ clinical records at the operation and pathological records were retrospectively evaluated for age, sex, body mass index (BMI), a history of diabetes mellitus, tumor depth, lymph node metastasis, pathological cancer stage, operation procedure, lymphadenectomy, reconstruction, post-operation infectious complications, neoadjuvant chemotherapy (NAC), adjuvant chemotherapy, and pancreatic enzyme administration. Patients’ pathological findings were recorded in accordance with the third English edition of the Japanese Classification of Gastric Carcinoma, which was edited by the Japanese Gastric Cancer Association [7]. Additionally, perioperative serum markers of nutrition and liver function, including total protein, albumin, total bilirubin, aspartate transaminase (AST), alanine transaminase (ALT), cholinesterase, total cholesterol, triglyceride levels, and FIB-4 index as well as any perioperative changes in terms of indicator level, were analyzed. Our study included 555 males and 166 females with a mean age of 68.4 years old. Out of 721 patients, 35 (4.9%) developed NAFLD 1 year after gastrectomy (NAFLD group) and 686 (95.2%) patients did not (non-NAFLD group).
Operative procedure We performed gastrectomy with lymphadenectomy for patients with gastric cancer in accordance with the Japanese gastric cancer treatment guidelines. After 2009, we introduced laparoscopic gastrectomy (laparoscopic distal gastrectomy, total gastrectomy, proximal gastrectomy, and pylorus-preserving gastrectomy) for selected patients with gastric cancer.
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Evaluation of hepatic CT attenuation values Unenhanced CT images were obtained via the singlebreath-hold technique using a 64 multidetector CT scanner (Aquilion 64; Toshiba Medical Systems, Tokyo, Japan). All patients underwent unenhanced CT before the operation for the preoperative diagnosis of gastric cancer and 1 ye
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