Incidence and Determinants of Steatotic Liver Disease after Pancreaticoduodenectomy: A Systematic Review and Meta-Analysis

Background: Steatotic liver disease (SLD) is an unrecognized complication after pancreaticoduodenectomy (PD) and may affect nutrition and long-term recovery. This meta-analysis estimated the incidence of SLD after PD and identified its clinical and surgical risk factors. Methods: MEDLINE and EMBASE were searched through March 2025 for studies reporting incident SLD after PD. Random-effects models generated pooled incidence and risk estimates. Subgroup, meta-regression, and sensitivity analyses assessed heterogeneity. Results: Forty-seven studies, including 6271 patients (mean age 65.8 ± 3.8 years; 42.9% female), predominantly from Asia, were included. The pooled incidence of SLD after PD was 26.2% (95% CI 22.6–30.3; I² = 90.5), with similar estimates across regions. Meta-regression demonstrated that the timing of postoperative imaging influenced reported incidence. A higher risk of SLD was observed in women (OR 2.11), patients with obesity (OR 1.88) or hyperlipidemia (OR 1.57), and those undergoing PD for pancreatic ductal adenocarcinoma (OR 2.78). The classical Whipple procedure (RR 1.64, 95% CI 1.36–1.97) and adjuvant chemotherapy (RR 1.62, 95% CI: 1.28–2.07) were also associated with increased risk, whereas pancreatic enzyme replacement showed no significant protective effect. Conclusions: Approximately a quarter of patients develop SLD after PD. These findings support longitudinal postoperative liver assessment and early nutrition-focused management in surgical practice.