Whipple's (Pancreaticoduodenectomy) Surgery: A Five-Year Clinical Experience in Gastrointestinal Surgery

Background: Pancreaticoduodenectomy (PD) is a complex surgical procedure commonly performed for periampullary and pancreatic malignancies.Although perioperative morbidity and mortality have improved over time, outcomes continue to vary across institutions.This study aimed to address the lack of regional data by evaluating the perioperative factors associated with early postoperative outcomes following PD over a five-year period at our institution.Method: This retrospective study included 83 patients who underwent PD between September 2018 and September 2023 at the Department of Gastrointestinal Surgery at B.P. Koirala Memorial Cancer Hospital, Bharatpur, Nepal.Preoperative, intraoperative, and postoperative variables were collected and analyzed.Postoperative complications were assessed according to standard definitions, and overall postoperative morbidity was quantified using the Comprehensive Complication Index (CCI).Patients were categorized into minor (CCI ≤23) and major (CCI >23) complication groups.Perioperative factors associated with major complications were evaluated using univariate and multivariable logistic regression analyses.Results: The mean age of the patients was 53.1±11.5 years, and 44 (53%) patients were male.Comorbidities were present in 53 (63.9%) patients.The mean BMI was 23.2±2.67 kg/m², while the median (IQR) preoperative bilirubin level was 6.32 (1.42-11.8)mg/dL, and the mean serum albumin level was 3.47±0.66g/dL.Ampullary carcinoma was the most common indication for surgery.Stage III disease was the most frequent pathological stage, occurring in 28 (33.7%)patients, followed by stage II disease in 27 (32.5%)patients.The mean operative time was 313±46.5 minutes, and the median (interquartile range (IQR)) intraoperative blood loss was 400 (300-585) mL.Major postoperative complications, defined as a CCI >23, occurred in 24 (28.9%)patients.Postoperative pancreatic fistula (POPF) developed in 26 (31.3%) patients, delayed gastric emptying (DGE) in 31 (37.3%),bile leak in 11 (13.3%), and postpancreatectomy hemorrhage (PPH) in two (2.4%).Overall postoperative mortality was 2.4% (two patients).On univariate analysis, age, preoperative bilirubin, serum albumin, intraoperative blood loss, soft pancreatic texture, POPF, DGE, and bile leak were significantly associated with major postoperative complications.On multivariable analysis, POPF (OR: 4.27; 95% CI: 1.38-13.20;p=0.012), bile leak (OR: 13.08; 95% CI: 2.38-71.80;p=0.003), and soft pancreas (OR: 3.03; 95% CI: 1.02-8.98;p=0.04) were independently associated with major postoperative complications.Age (OR: 1.05; 95% CI: 0.99-1.10;p=0.05) and preoperative bilirubin (OR: 1.54; 95% CI: 0.98-2.41;p=0.05) demonstrated borderline associations.Conclusion: Our study suggests that soft pancreatic texture showed a strong association with major complications, while older age and higher preoperative bilirubin demonstrated borderline associations.Among the postoperative factors, the occurrence of POPF and bile leak was strongly associated with major postoperative complications.Early identification of these morbidity factors and appropriate optimization and mitigation strategies may help reduce postoperative complications.Prospective studies evaluating morbidity factor modification and optimization, with larger study populations and long-term follow-up, are warranted to validate these findings and improve outcomes after PD.