Understanding Risk Factors in Pancreaticoduodenectomy: Insights for Surgical Oncologists

A retrospective cohort shows that measurable patient factors—MELD‑Na, ACCI, and neutrophil‑to‑lymphocyte ratio (NLR)—independently predict 90‑day mortality after pancreaticoduodenectomy, with direct implications for perioperative planning and resource allocation.

In this retrospective cohort of periampullary cancer patients undergoing pancreaticoduodenectomy, investigators defined 90‑day postoperative mortality as the primary endpoint and evaluated demographic, laboratory, and comorbidity variables.

What do these markers mean for risk? The MELD‑Na score reflects hepatic dysfunction and was associated with substantially higher 90‑day mortality in this cohort. ACCI captures aggregated comorbidity burden; higher ACCI amplified postoperative risk independent of chronological age. Elevated NLR served as a surrogate inflammatory index, with higher ratios correlating with poorer early postoperative survival. Combined, these measures offer a more refined, multivariable risk stratification to guide perioperative planning.

High‑volume hepato‑pancreato‑biliary centers typically report better outcomes; these findings add a patient‑level axis for evaluating surgical risk. Applying MELD‑Na, ACCI, and NLR alongside institutional volume metrics can tailor patient selection and the intensity of perioperative monitoring—complementing, not supplanting, volume‑based quality efforts.

That risk profile supports multidisciplinary mitigation: preoperative optimization of hepatic status where clinically feasible, focused management of comorbid conditions reflected in the ACCI, and intensified perioperative care and earlier surveillance for patients with elevated NLR. Multidisciplinary case review that explicitly incorporates these metrics can help prioritize resources and contingency planning. In practice, targeted optimization and monitoring could reduce 90‑day mortality.

Targeted implementation and prospective monitoring of these risk‑directed interventions are the logical next steps.

Key Takeaways:

• Retrospective cohort analysis identifies MELD‑Na, ACCI, and NLR as independent predictors of 90‑day mortality after pancreaticoduodenectomy.
• Combining hepatic, comorbidity, and inflammatory measures refines perioperative risk stratification.
• Multidisciplinary optimization and focused postoperative surveillance should be piloted to assess impact on 90‑day mortality.