• Langue : Anglais, Français
• Discipline : Médecine. Chirurgie digestive et générale
• Identifiant : 2024ULILM300
• Type de thèse : Doctorat de médecine
• Date de soutenance : 04/10/2024

Résumé en langue originale

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Résumé traduit

Introduction: Pancreatic Ductal Adenocarcinoma (PDAC) is the 6th cause of cancer mortality worldwide, 4th in France, with numbers increasing each year. On the other hand hepatic steatosis, a well know surgical complication after pancreatic surgery is becoming a public health issue, with Non Alcoholic Fatty Liver Disease (NAFLD) being now the first chronic hepatopathy in the world, which may lead to Non Alcoholic Steato Hepatitis (NASH) and in extreme cases, cirrhosis and hepatocarcinoma. Sarcopenia, which consists in lower muscle mass, especially frequent in patients with oncological pathologies shares multiple physiopathological mechanisms factors with hepatic steatosis. To our knowledge no study has been made about the imbrications between sarcopenia and hepatic steatosis in pancreatic surgery.This is why we wanted to determine whether or not pre-operative sarcopenia before Pancreaticoduodenectomy (PD) for PDAC had an impact on liver attenuation before and after surgery. Methods: We included 109 patients, from Lille University Hospital, who underwent PD between 2011 and 2020. Pre-operative sarcopenia was assessed using Skeletal Muscle Index (SMI) measurements, and cut-offs for the sarcopenic group were 38.9 cm²/m² for women and 55.4 cm²/m² for men. We measured liver density on pre and post-operative CT scans at 1-6 months and after 6 months. Liver density attenuation between pre-operative and 1-6 months CT scans was compared between our sarcopenic and non sarcopenic groups. Results: No significant difference was shown between our two groups in terms of liver density attenuation before and after surgery (p = 0.97). We also used univariate and multivariate analysis to try and determine risk factors for post-operative hepatic steatosis (mean hepatic density < 40 HU), a lower age was a risk factor for hepatic steatosis in both analysis (OR: 0.571, CI (0.36-0.89), p = 0.01, in the multivariate analysis) and a higher BMI was a risk factor for hepatic steatosis in the multivariate analysis (OR: 1.617, CI (1.02-2.57), p = 0.04), which is consistent with previous studies. Conclusion: Pre-operative sarcopenia had no significant impact on liver density attenuation before and after surgery in our study. Further studies especially prospective ones should be considered to precise our results.