Extended versus standard pancreatectomy for pancreatic and periampullary tumours: a single center cohort study on surgical and oncological outcomes

Introduction Pancreatic and periampullary cancers are associated with a poor prognosis. The only potentially curative treatment is surgery, and preferably combined with adjuvant chemotherapy. This study aims to compare surgical and oncological outcomes between standard and extended pancreatectomy. Method Retrospective single-center study (2009–2022). Short- and long-term outcomes were compared between standard and extended pancreatectomy (ISGPS definition). Long-term survival was compared across surgical and palliative groups. Result A total of 575 patients underwent resection with curative intent (125 extended, 450 standard). Preoperative comorbidities were similar. Extended pancreatectomy was associated with longer operative time (469vs. 420 min,p<0.001), greater blood loss (500 vs. 350 ml, p<0.001), more often both intraoperative transfusion (24% vs. 10%,p<0.001), and ICU stay (9%vs. 4%,p=0.042). Hospital stay, major complications (Clavien-Dindo≥3), readmissions, and 30-/90-day mortality did not differ. Adjuvant chemotherapy was more common in the extended group (85% vs. 76%,p=0.025), with similar completion rates (72%vs. 73%,p=0.945). Disease-free survival was shorter (13.3vs. 22.5 months,p<0.001), and estimated 5-year survival lower (18%vs. 30%,p<0.001). Median survival for standard surgery was 39.6 months, compared to 26.4 months for extended surgery, which was still longer than the palliative group (5.0 months). Median survival for patients with exploration without resection due to metastases or local owergrowth was 11.4 and 17.6 months. Discussion Extended pancreatectomy was associated with increased operative complexity but did not worsen morbidity or short-term mortality. Despite more adjuvant chemotherapy, long-term survival was worse compared to standard pancreatectomy. However, extended surgery provides a survival benefit over palliative treatment, offering a feasible option in selected patients with potentiall long-term benefits.