Background and Aims Sarcopenia can lead to an increased risk of adverse events such as limb dysfunction, decreased quality of life, and death. Studies on the influences of sarcopenia on patients undergoing pancreaticoduodenectomy (PD) are scarce and the findings are inconsistent. This study was conducted to systematically evaluate the effects of sarcopenia on postoperative clinical outcomes in patients undergoing PD to improve clinical outcomes through effective interventions.Methods Relevant literature was searched using PubMed, Embase, Cochrane Library, CNKI, VIP, and Wanfang databases from the time of database inception to June 1, 2022. After literature screening, information extraction and evaluation of the quality and risk of bias of the included studies by two independent investigators, the data were analyzed using RevMan 5.3 software.Results Fourteen studies with a total of 2 198 patients were included, with 737 patients in the sarcopenic group and 1 461 patients in the non-sarcopenic group, all of which were cohort studies. Meta-analysis showed that there were no significant differences in operative time and incidence rates of wound infection, urinary tract infection, biliary fistula, and postoperative bleeding between the two groups (all P>0.05); in the sarcopenic group compared with the non-sarcopenic group, the preoperative BMI value (WMD=-1.22, 95% CI=-1.82-0.62, P<0.001) and preoperative albumin level (WMD=-0.30, 95% CI=-0.41-0.19, P<0.001) were lower, intraoperative blood loss was higher (WMD=88.12, 95% CI=6.94-169.31, P<0.05), the incidence rates of overall postoperative complications (OR=3.53, 95% CI=2.52-4.94, P<0.001), complications graded Clavien-Dindo ≥3 (OR=1.57, 95% CI=1.17-2.12, P=0.003), bacteremia (OR=4.46, 95% CI=1.42-13.98, P=0.01), pneumonia (OR=2.07, 95% CI=1.31-3.25, P=0.002), and pancreatic fistula (OR=1.34, 95% CI=1.05-1.72, P=0.02) were higher; the hospital stay was prolonged (OR=3.18, 95% CI=1.97-4.39, P<0.001), and mortality was increased (OR=3.17，95% CI=1.55-6.50，P=0.002).Conclusion There is a high proportion of patients undergoing PD with preoperative comorbid sarcopenia. The concomitant sarcopenia has a detrimental influence on the clinical outcomes of patients, as evidenced by increased complication and mortality rates and lengthened hospital stay.