Prognostic factors for overall survival after extended pancreatectomy

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Abstract Introduction Extended pancreatectomy (EP) enables resection in selected patients with locally advanced pancreatic and periampullary tumours. This study aimed to identify factors associated with overall survival following EP. Methods Consecutive patients who underwent EP for pancreatic or periampullary adenocarcinoma at a tertiary centre 2010–2022 were included. EP was defined according to International Study Group of Pancreatic Surgery (ISGPS) criteria. Data were retrieved from a national registry and supplemented by chart review. Cox proportional hazards regression was used to evaluate factors associated with overall survival (OS) in two multivariable models: one including preoperative variables and one including postoperative variables. Results A total of 125 patients underwent EP, with a median age of 70 [IQR 63–75] years, including 106 (84.8%) with venous resection. Median overall survival was 27 months, with a 3-year survival of 33%. In the preoperative model, ASA III–IV (HR 1.74, 95% c.i. 1.10–2.73), preoperative anaemia (Hb <120 g/l; HR 1.59, 95% c.i. 1.05–2.41), and diabetes mellitus (HR 1.57, 95% c.i. 1.00–2.47) were independently associated with worse survival. In the postoperative model, nodal involvement (HR 2.45, 95% c.i. 1.33–4.54), R1 resection (HR 1.71, 95% c.i. 1.12–2.62), and biliary leakage (HR 6.89, 95% c.i. 1.92–24.73) were independently associated with impaired survival. Discussion OS after EP was associated with both patient-related and tumour-related factors. Preoperative risk factors may support patient selection and optimisation, while tumour biology and postoperative complications are key determinants of outcome, highlighting the importance of both preoperative and postoperative decision-making.

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