Tumor location and histogenesis as risk factors for early complications and mortality following multivisceral surgical procedures with pancreatoduodenectomy

Aim. To investigate the role of tumor localization and histogenesis as risk factors for postoperative complications and mortality following multivisceral surgical procedures involving pancreaticoduodenectomy.

Materials and Methods. This study included all patients (n = 251) who underwent multivisceral surgery with pancreaticoduodenectomy for tumors of various localizations at two medical institutions.

Results. Comparative analysis of pancreatic parenchymal density revealed statistically significant differences between pancreatic cancer and cancer of the major duodenal papilla (p = 0.012), distal common bile duct cancer (p = 0.040), duodenal tumors (p < 0.001), secondary pancreatic tumors (p < 0.001), colorectal cancer (p < 0.001), renal cancer (p = 0.027), and gastric cancer (p < 0.001). Statistically significant differences were also observed in the following pairwise comparisons: major duodenal papilla cancer vs. colorectal cancer (p = 0.010); neuroendocrine tumor of the pancreatic head vs. colorectal cancer (p < 0.001); pancreatic neuroendocrine tumor vs. gastric cancer (p = 0.006). For pancreatic duct diameter, significant differences were found between duodenal tumors and pancreatic cancer (p = 0.016), colorectal cancer and pancreatic cancer (p < 0.001), gastric cancer and pancreatic cancer (p = 0.016). The overall rate of postoperative complications in the study group was 65.7% (n = 165), with a mortality rate of 7.2% (n = 18). The likelihood of developing a postoperative pancreatic fistula was significantly higher in patients with distal common bile duct cancer (AOR 5.9; 95% CI: 1.4–24.6, p = 0.015), secondary malignancies of the pancreatic head (AOR 4.7; 95% CI: 1.06–21.0, p = 0.041), and gastric cancer (AOR 2.8; 95% CI: 1.048–7.691, p = 0.040). The risk of dehiscence of pancreatic-digestive anastomosis significantly increased in patients with distal common bile duct cancer (AOR 7.8; 95% CI: 1.7–35.05, p = 0.007). In patients with secondary malignancies of the pancreatic head, postoperative mortality was significantly higher (AOR 9.7; 95% CI: 1.79–52.8, p = 0.008).

Conclusion. Tumor localization and histogenesis may serve as independent predictors of early outcomes following multivisceral surgery with pancreatoduodenectomy. Cancer of the pancreatic head generally has the most favorable prognosis among pancreatic tumors, and its location is associated with a lower risk of postoperative complications. In contrast, surgeries for distal common bile duct cancer, metastatic lesions of the pancreatic head, and gastric cancer are associated with significantly worse short-term outcomes.

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