Fatty pancreas disease (FPD) refers to excessive fat accumulation and fat infiltration in pancreatic tissue. Factors such as obesity, diabetes, non-alcoholic fatty liver disease (NAFLD), and alcohol consumption can contribute to the development of FPD. Patients with FPD typically lack obvious clinical symptoms or signs, and diagnosis primarily relies on imaging techniques. Currently, there is limited attention to this disease both domestically and internationally. FPD is closely associated with pancreatic-related diseases (eg, diabetes, pancreatitis, pancreatic cancer). Pancreatic cancer, characterized by high mortality and low survival rates, has been linked to FPD in terms of its occurrence, progression, and patient prognosis. FPD is considered a potential early clinical manifestation of pancreatic cancer and may promote distant metastasis. However, the mechanisms by which FPD contributes to pancreatic carcinogenesis remain unclear. Additionally, Studies have found that FPD can lead to perioperative complications (postoperative pancreatic fistula, postoperative nonalcoholic fatty liver, endoscopic retrograde cholangiopancreatography pancreatitis), which are closely related to the prognosis of patients after pancreatic surgery.Although FPD is challenging to diagnose, its instability allows for clinical management through early dietary interventions, oral medications, and, when necessary, bariatric surgery to alter disease progression. Whether targeting adipocytes, lipid metabolism, or adipocyte-related cytokines could serve as novel intervention strategies for pancreatic cancer remains a critical area for further investigation.© 2025 Wu and Li.