Predictors of Major Postoperative Complications After Pancreaticoduodenectomy for Periampullary Tumors

Background: Pancreaticoduodenectomy (PD) is one of the most complex surgical procedures and remains associated with substantial postoperative morbidity. Identification of factors associated with severe postoperative complications may improve perioperative management and patient outcomes. Methods: Patients aged 18 years or older who underwent elective pancreaticoduodenectomy for periampullary tumors between January 2021 and January 2026 were retrospectively reviewed. Demographic characteristics, preoperative laboratory findings, percutaneous transhepatic cholangiography(PTC) and endoscopic retrograde cholangiopancreatography(ERCP) history, operative details, length of hospital stay, and postoperative complications were analyzed. Factors associated with severe complications (Clavien-Dindo Grade III or higher) were evaluated using univariate and multivariate analyses. Results: A total of 84 patients were included. The rates of pancreatic fistula were 22.6%, 6.0%, and 3.6% for Grade A, B, and C, respectively, yielding an overall fistula rate of 32.2%. Severe complications occurred in 30.9% of patients. Univariate analysis demonstrated significant associations between severe complications and preoperative albumin level, malignant-benign pathology distinction and pancreatic fistula. Multivariate analysis identified low preoperative albumin level (p=0.013), malignant pathology (p=0.013) as independent factors associated with severe postoperative complications. Conclusions: Severe postoperative complications remain common following PD. Low preoperative albumin levels, malignant pathology were independently associated with severe complications. Particular attention should be given to patients with hypoalbuminemia and malign pathology undergoing elective PD.