Pancreato-duodenal cancers in Pakistan: Patterns of presentation, disease burden and outcomes at a tertiary cancer facility.

Introduction: Cancers of the pancreato-duodenal region carry a poor prognosis and are resource-intensive to manage. Long-term data from specialized cancer centers in Pakistan are limited. We aimed to determine the long-term outcomes of patients with duodenal, peri-ampullary, distal bile duct, and pancreatic cancers treated at a tertiary cancer center in Pakistan. Material and methods: We retrospectively evaluated data from all patients with pancreaticoduodenal cancer registered at our institute between January 2000 and December 2020. The Kaplan-Meier method was used to examine significant differences in survival distributions across subcategories, with results considered significant at an alpha level of 0.05. SPSS 27 was used for descriptive and comparative data analysis. Results: The mean age at presentation was 53 years, with peri-ampullary cancers being the most common histology. Pancreatic cancers were associated with poor prognosis as compared to duodenal cancers and pancreatic Neuro-Endocrine Tumors (pNET). For patients with pNET undergoing resection, the 5-year overall and disease-free survival was 90% and 75%, respectively. Patients who achieved textbook outcomes after surgery had better OS and DFS. Discussion: The current study showed that in our part of the world, patients are younger and have advanced stages at the time of diagnosis of pancreato-duodenal cancers. We also found that the long-term survival is associated with an early stage at diagnosis.