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Background: Pancreatic ductal adenocarcinoma (PDAC) has a 5-year survival rate of less than 10%. Treatment with curative intent surgery still poses high rates of overall postoperative morbidity (68.7%) and mortality (5.4%). It is therefore essential to identify preoperative factors influencing early postoperative outcomes to provide better insight for improved patient selection and care.

Methods: Sixty patients diagnosed with PDAC who had undergone surgical resection at Groote Schuur Hospital, Cape Town, between 2016 and 2023 were included. The patient cohort was divided into two groups, postoperative survival ≤ 90 days vs > 90 days. The groups were compared regarding demographic and preoperative assessment tools using ASA, ECOG and Codman scores, baseline clinical and imaging data, preoperative treatment and surgical related parameters.

Results: Significant differences were found in patients, with patients presenting with pancreatic duct dilation (p < 0.05), tumour location in the pancreatic head (p < 0.05), elevated gamma-glutamyl transferase (GGT) (p < 0.01) and carbohydrate antigen 19-9 (CA19-9) (p < 0.05). Using regression analysis, GGT serum levels > 500 U/L were correlated with mortality ≤ 90 days, while pancreatic duct dilatation and CA19-9 levels > 200 U/L were associated with survival > 90 days.

Conclusions: The results of this study present important insights regarding risk factors influencing postoperative mortality and offer a potential roadmap for optimising preoperative care and judicious patient selection before pancreatic surgery.