This nationwide cohort study used the Dutch Pancreatic Cancer Audit (2014–2020) to evaluate whether pathological diagnosis independently affects major postoperative complications (Clavien-Dindo ≥3) after pancreatoduodenectomy across 8 diagnostic groups, and to assess inter-hospital variation in case-mix.
Among 4,152 patients, major complication rates ranged from 21.8% (chronic pancreatitis) to 43.9% (PanNET). On multivariable analysis, all diagnoses except chronic pancreatitis carried significantly higher odds of major complications vs. PDAC; adjusted ORs were highest for PanNET (2.59; 95% CI 1.84–3.65) and duodenal adenocarcinoma (2.32; 95% CI 1.77–3.03).
- Registry-based design limits granular clinical detail (e.g., pancreatic texture, duct diameter, surgeon volume) that may confound results. - Only Dutch centers included, which may limit generalizability to health systems with different surgical volumes or case-mix. - Cause-specific complication types (e.g., postoperative pancreatic fistula rates by diagnosis) were not fully detailed in the abstract.
When benchmarking pancreatoduodenectomy outcomes across hospitals, audits should include pathological diagnosis as a covariate — especially since PanNET and duodenal adenocarcinoma carry more than double the complication risk of PDAC. Surgeons and quality teams should anticipate higher morbidity in these subgroups and counsel patients accordingly.
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