Surgical Management of Pancreatic cancer in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: A 5 years retrospective hospital-based study

Abstract

Abstract Introduction: Pancreatic cancer is one of the most lethal human cancers. It ranks fourteenth in terms of new cancers cases in 2020 and it is the seventh leading cause of cancer-related deaths worldwide. The incidence is different in different parts of the world. It is a cancer with the worst prognosis of all malignancies. Pancreatic cancer is predominantly a disease of an older population. There are different environmental (modifiable) and non-modifiable risk factors associated with the development of pancreatic cancer. The clinical manifestation is determined by tumor site. At present, surgical resection is the only potential cure for pancreatic cancer. However, as only 10–20% of the patients have resectable disease at the time of diagnosis, the role of surgical palliation is significant in resource limited setups like ours. Although the perioperative morbidities of surgeries for pancreatic cancers remain high the perioperative mortality has shown significant reduction in the past few decades. Numerous reports have been published by western countries on this disease entity but only few works have been done in Africa and to the best of our knowledge, no study has been conducted to investigate pancreatic cancer in Ethiopia. Objectives To assess the clinico-pathologic profile, associated factors, surgical management and short-term outcome of patients with pancreatic cancer in Tikur Anbessa Specialized hospital. Methods A 5 years retrospective hospital-based cross-sectional study was conducted on 52 patients operated with the diagnosis of pancreatic cancer with either curative or palliative intents. The study period was from April 2016 to July 2021. The data collected includes demographic profile, associated risk factors and comorbidities, clinical presentations, biochemical parameters, pathologic features of the tumors as well as type of treatment offered and short term treatment outcome. The data was analyzed using SPSS version 25. Result The mean and median age of patients was 54.1 and 54.5% respectively. Males constitute about 52% the patients. 21% of the patients have potential risk factors; whereas only 10 (19.2%) of the patients had medical comorbidities. Median duration of symptoms at diagnosis was 12 weeks. Abdominal pain (88.5%) was the most common presenting symptom followed by anorexia (80.8%) and significant weight loss (78.8%), while 71.2% of the patients have jaundice. On clinical evaluation, 69.2% were jaundiced, while 34.6% had a palpable gallbladder. More than two third of patients presented with advanced disease. 76.9% of the tumors are located in the head of pancreas. More than three quarters (77%) of the surgeries performed were palliative. Postoperative morbidity and mortality were 19.2% and 3.8% respectively. Conclusion Age at first diagnosis of pancreatic cancer is relatively earlier in our setup. Most patients present with advanced condition, only amenable for palliative measures. The post-operative outcome is in our setup is acceptable. The need for adjuvant therapy in pancreatic cancer cannot be over emphasized