Preoperative Aortic Calcification Volume Predicts Postoperative Complications in Nonpancreatic Cancer Patients Undergoing Pancreaticoduodenectomy

Background/Objectives Postoperative complications following pancreaticoduodenectomy (PD) remain high, particularly in patients with soft pancreatic texture. Abdominal aortic calcification volume (AACV), a surrogate marker of systemic arteriosclerosis, has been associated with increased surgical risk in lower gastrointestinal procedures; however, its relevance in hepatopancreatobiliary surgery has not been well established. This study aimed to evaluate the clinical significance of AACV in predicting postoperative complications after PD. Methods We retrospectively analyzed 182 patients who underwent PD for nonpancreatic malignancies at our institution between January 2007 and December 2023. AACV was measured using the SYNAPSE VINCENT 3D imaging system, assessing calcification from the renal artery to the common iliac artery bifurcations on preoperative CT. Clinical characteristics and short‐term postoperative outcomes were evaluated. Results The cohort included distal cholangiocarcinoma (57.1%), papillary carcinoma (35.7%), duodenal cancer (2.7%), IPMN (2.2%), and pancreatic neuroendocrine tumors (1.6%). Soft pancreatic texture was observed in 85.2% of patients. The median AACV was 894.5 mm 3 (range: 284.6–2951.9) and correlated weakly with age ( r = 0.377, p < 0.001). Patients with Clavien–Dindo grade≥IIIa complications had significantly higher AACV than those without (1745.9 vs. 751.9 mm 3 , p < 0.001). AACV was identified as an independent predictor of both severe complications (HR: 10.9; 95% CI: 4.44–26.3) and POPF≥Grade B (HR: 4.85; 95% CI: 2.2–10.8). Conclusion AACV is significantly associated with severe postoperative complications and clinically relevant pancreatic fistula following PD, particularly in patients with nonpancreatic malignancies. It may serve as a valuable preoperative risk predictor in this population.