Resection rates and predictors of resectability of pancreatic tumors at mulago hospital, a retrospective cross sectional study

Abstract

Abstract Background: Pancreatic tumors are highly lethal, ranking 12th in global incidence and seventh in cancer-related mortality. Surgical resection remains the only potential cure, improving 5- year survival from 9–17.5%. However, in low-income countries, most patients present with advanced disease, limiting surgical eligibility. Accurate preoperative assessment using clinical, biochemical, and radiological factors is essential for identifying candidates likely to benefit from surgery. This study evaluated predictors of resectability of pancreatic tumors at Mulago National Referral Hospital, MNRH. Methodology: A retrospective cross-sectional review of 100 patients admitted with pancreatic tumors at MNRH between January 2021 and December 2024 was conducted. Data included clinical symptoms such as jaundice, abdominal pain, and weight loss, biochemical markers including CA 19-9, CEA, hemoglobin, and bilirubin, and radiological findings such as tumor location, size, lymph node involvement, metastases, and vascular invasion. Preoperative resectability and operative outcomes were documented. Associations between predictors and resectability were analyzed using chi-square and multivariate logistic regression, with significance set at p < 0.05. Results: The overall resection rate was 21%. While 55% were deemed resectable on imaging, 61.8% were found intraoperatively to be unresectable, largely due to vascular invasion and distant metastases. Most tumors arose in the pancreatic head, 92%, and 51% of patients presented with late-stage disease. On univariate analysis, tumor size greater than 4 cm, lymph node involvement, and metastasis were associated with irresectability. In multivariate analysis, only tumor size greater than 4 cm remained an independent predictor with an adjusted odds ratio of 0.054, 95% confidence interval 0.015–0.193, and p < 0.001. Other factors, including CA 19-9, CEA, hemoglobin, and tumor location, were not significant. Conclusions: The majority of pancreatic tumors at MNRH were unresectable at surgery despite favorable preoperative imaging. Tumor size less than 4 cm was the only independent predictor of resectability. Enhanced imaging and incorporation of tumor size into preoperative evaluation may improve surgical decision-making and outcomes.