Risk factors for postoperative complications following pancreatic resections – a single-center observational study

<b>Introduction:</b> The survival of pancreatic cancer patients is only possible with radical surgery, complemented by chemotherapy. Effectively addressing postoperative complications (PC) following pancreatic resections (PR) is linked to elevated mortality rates (MRs). Identifying risk factors after PR, particularly those that are modifiable, has the potential to enhance treatment outcomes. Regarding local and distal tumor progression, a significant proportion of patients require neoadjuvant chemotherapy (NACT), which subsequently enables surgical intervention in selected individuals.<b>Aim:</b> The aim of this study was to assess risk factors associated with PC in patients who underwent pancreatoduodenectomy (PD) or distal pancreatectomy (DP), with or without NACT.<b>Material and methods:</b> We evaluated 176 patients with pancreatic cancer treated with 1) PD with or 2) without NACT and 3) DP with or 4) without NACT in our tertiary care university hospital. We conducted a single-center retrospective study to summarize our experience with major surgical complications (MSCs) after pancreatectomy, including one of the most severe – postoperative pancreatic fistula (POPF).<b>Results:</b> Soft pancreatic parenchyma, longer operative times and increased Charlson Comorbidity Index (CACI) were associated with increased risk of POPF after PD without NACT. Diabetes mellitus (DM) and round ligament flap application were associated with a reduced risk of POPF following DP. In patients after DP without NACT, CACI and longer operative times were risk factors for MSCs.<b>Conclusions:</b> Only a select group of patients with pancreatic cancer can benefit from upfront surgery before chemotherapy. The risk of PC in various types of pancreatic cancer resections is associated with multiple factors: CACI, tumor size, DM, round ligament flap application for POPF, and CACI, operative time for MSCs.