Sex-Specific Trajectories of Muscle Mass and Steatotic Liver Disease After Total Pancreatectomy: A 10-Year Follow-Up Study

Objectives: Total pancreatectomy (TP) is an invasive surgery, resulting in pancreatic endocrine and exocrine dysfunction. With increasing indications for pancreatic neoplasms, including pancreatic ductal adenocarcinoma (PDAC), understanding long-term metabolic adaptation after TP is essential for survivorship care. Methods: We retrospectively analyzed 160 TP cases at our institute and evaluated the prognosis. A subset of 20 long-term survivors (>10 years) underwent longitudinal assessment of nutritional parameters, body mass index (BMI), skeletal muscle index (SMI), and steatotic liver disease (SLD) preoperatively and at 3–6 months, 1, 5, and 10 years postoperatively. Results: PDAC patients (n = 87) had significantly worse survival than non-PDAC patients (n = 73) (10-year survival: 16.2% vs. 70.7%; HR, 6.92; P < 0.001). Serum albumin recovered within 3–6 months and remained stable for 10 years. BMI recovered in both sexes by 5 years, but muscle mass showed a striking sex disparity. Males regained preoperative SMI, while females suffered persistent loss (35.5 to 30.9 cm²/m² at 10 years). The new-onset SLD occurred far more frequently in females (37.5% at 3–6 months; 55.6% at 1 year) than males (0–11.1%). Notably, the dramatic reduction of BMI and SMI was more frequently associated with the development of SLD after TP in females than in males. Conclusions: This is the first study to describe the sex-specific long-term metabolic changes after TP. Females experienced persistent muscle loss and new-onset SLD after TP, highlighting the need for sex-specific long-term follow-up to improve quality of life and outcomes.