Effect of reduction in skeletal muscle quantity and sex differences on postoperative hepatic steatosis following total pancreatectomy

PURPOSE: This study aimed to determine the risk factors for new-onset hepatic steatosis after total pancreatectomy (TP), focusing on muscle loss and sex. METHODS: We retrospectively analyzed 100 patients who underwent TP between 2005 and 2024. Nutritional parameters, BMI, muscle volume, and liver status were evaluated. Logistic regression and subgroup analyses were performed to identify the risk factors for hepatic steatosis. RESULTS: The prevalence of hepatic steatosis increased from 3.0% preoperatively to 24.0% at 3-6 months after TP. Female patients showed a significantly higher incidence of hepatic steatosis than male patients (37.8% vs. 12.7%, respectively). A multivariate analysis identified female sex (odds ratio: 7.77, 95% confidence interval: 2.03-29.8, p = 0.009), younger age (0.93, 0.88-0.98, 0.011), and higher preoperative BMI (1.28, 1.05-1.63, 0.015) as independent risk factors. Among the female patients, a younger age, one-stage TP, greater reductions in SMI, portal vein resection, longer operative time, greater blood loss, and diarrhea at discharge were associated with new-onset hepatic steatosis. However, a lower intraoperative blood loss potentially contributes to recovery from hepatic steatosis after TP. CONCLUSIONS: A female sex is a high risk factor for hepatic steatosis after TP. Reducing operative stress and preserving muscle volume may facilitate the prevention and recovery from hepatic steatosis.