Hamza Çınar, Utku Özgen
Background: Pancreaticoduodenectomy (PD) remains the standard surgical treatment for pancreatic head and periampullary malignancies, but it is associated with significant postoperative morbidity and mortality. This study evaluated early postoperative outcomes following PD and factors associated with complications and mortality.Methods: This retrospective single-center study included 34 consecutive patients who underwent curative pancreaticoduodenectomy for pancreatic or periampullary malignancies between January 2024 and June 2026. Demographic, perioperative, pathological, and postoperative data were analyzed. Clinically significant postoperative pancreatic fistula (POPF), bile leakage, postpancreatectomy bleeding (PPH), and 30- and 90-day mortality were evaluated. Univariate analyses were performed to identify factors associated with postoperative outcomes.Results: The median age of the patients was 64, and 64.7% were male. The most frequent histopathological diagnosis was pancreatic ductal adenocarcinoma (50.0%). POPF, bile leakage, delayed gastric emptying, and intraabdominal abscess each occurred in 17.6% of patients, while PPH developed in 14.7%. Overall 30-day and 90-day mortality rates were 11.8% and 14.7%, respectively. Low body mass index (BMI) was significantly associated with both 30-day (p=0.003) and 90-day mortality (p=0.002). Longer operating time (p=0.038) and tumor type/location (p=0.044) were associated with 30-day mortality, while firm pancreatic tissue was significantly associated with PPH (p=0.048). No significant association was observed between preoperative bile drainage and postoperative outcomes.Conclusions: PD can be performed in specialized centers with acceptable early postoperative outcomes. Low BMI is the strongest predictor of postoperative mortality, highlighting the importance of preoperative nutritional assessment and optimization. Larger prospective multicenter studies are needed to confirm these findings.