Mortality Rate of Oncological Patients Undergoing Pancreaticoduodenectomy Procedure in Brazil From 2021 to 2023: A Cross-Sectional Study

PURPOSE Pancreatic cancer is the fourth leading cause of cancer death for men and the fifth for women. The current standard therapy for pancreatic tumors situated in the head of the pancreas is pancreaticoduodenectomy. However, this surgery is associated with significant postoperative morbidity. Great improvement in pancreatic surgery has led to mortality rates of less than 5% at high-volume centers, and the majority of case series in the literature reported a mortality rate of 8%. The study aims to analyze the mortality rate over three-years among Brazilian regions associated with treatment by pancreaticoduodenectomy in oncological patients. METHODS A cross-sectional study was designed using data collected from DATASUS, a Brazilian Health Ministry database. The study compared and analyzed the number of deaths and the total number of pancreaticoduodenectomies performed on oncological patients among Brazilian macro-regions (North, Northeast, Southeast, South, and Midwest) in the period of 2021 to 2023. Statistical analysis was performed using SPSS software v.18. RESULTS In this three-year, 1,871 pancreaticoduodenectomies were performed on oncological patients in Brazil. The year with the highest number of surgeries was 2021, with 633, and the year with the lowest number was 2022, with 611. Among these cases, 268 patients died during the procedure or in the postoperative period 14.32% of patients. The Southeast region had the highest number of pancreaticoduodenectomies, 979, and the highest number of recorded deaths, 139. However, its mortality rate is the second lowest among the five regions (14.20%). The South region, with the second highest number of surgeries and deaths, had the highest mortality rate, 16.16%. CONCLUSION Brazil had a significantly higher mortality rate than what is presented in the literature. Nevertheless, the number of surgeries performed in the country was significantly low in four of the five regions, but the Southeast region, with a considerable number of pancreaticoduodenectomies, also had a high rate. Two databases, from an American study and a French study, reported that mortality rates were significantly higher in lower-volume services. Another detail is the profile of the populations evaluated. Brazil tends to have a more compromised socioeconomic level.