Pancreatic steatosis and pancreatic cancer: from cancer carcinogenesis to surgical management / 中华消化外科杂志

ABSTRACT

Obesity, alcohol consumption and metabolic diseases can cause the accumula-tion and infiltration of adipocytes in pancreatic tissues, resulting in pancreatic steatosis (PS). There is little clinical concern about PS, which has not yet attracted the attention of the physicians. How-ever, previous studies have confirmed that PS is associated with the carcinogenesis, development, surgical complications and prognosis of pancreatic cancer (PC). Within the environment of PS, adipocytes, macrophages and other inflammatory cells infiltrate among the acinar cells, aggravating the local inflammation in pancreatic tissue, stimulating the atypical hyperplasia of the pancreatic duct epithelium, and promoting the occurrence of PC. Patients with PS have a significantly higher incidence of PC and are more susceptible to lymph node metastasis, with worse long-term prognosis. The texture of pancreas become soft and fragile under the condition of PS, and the risk of pancreatic fistula and its related complications evidently increase after pancreatic resections. In terms of imaging examinations, it is common to use abdominal computed tomography or magnetic resonance imaging for the diagnosis of PS. In addition, a large number of adipocytes infiltration in pancreatic acinar tissue can confirm the diagnosis of PS histologically. Surgeons should pay more attention to PS, be familiar with its diagnostic criteria and clinical significance, and take active prevention and early intervention to reduce the occurrence of PC. Regard to PC patients complicated with PS, blood glucose, blood pressure and other metabolic diseases should be well controlled during the perioperative period, surgical details should be comprehensively considered to ensure the quality of pancreatojejunostomy and reduce postoperative complications. Combined with self-experience, the author comprehensively analyzes research advances at home and abroad, summarizes the role of PS in the occurrence and development of PC and its important influence on clinical diagnosis and treatment, and explores the perioperative management strategy of PC patients with PS.