Resection Rates and Predictors of Resectability of Pancreatic Tumors at Mulago Hospital, A Retrospective Cross Sectional Study

Resection Rates and Predictors of Resectability of Pancreatic Tumors at Mulago Hospital, A Retrospective Cross Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Resection Rates and Predictors of Resectability of Pancreatic Tumors at Mulago Hospital, A Retrospective Cross Sectional Study Godfrey Kikuba, Brian Kasagga, Paul Ssempembwa, Olivia Kituuka, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7535609/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Pancreatic tumors are among the most lethal malignancies globally, with surgical resection being the only curative option. However, in low-income countries, most patients present at advanced stages, limiting surgical eligibility. Accurate preoperative prediction of resectability is essential for effective surgical planning. This study evaluated clinical, biochemical, and radiological predictors of pancreatic tumor resectability at Mulago National Referral Hospital (MNRH). Methods We conducted a retrospective cross-sectional study of 100 patients diagnosed with pancreatic tumors between January 2021 and December 2024. Demographic, clinical, biochemical, and radiological data were collected. Resection rates were calculated. Associations between independent variables and resectability were first explored using independent-samples t-tests and crude odds ratios. Predictors were then assessed with univariate and multivariate logistic regression models to obtain adjusted odds ratios. P < 0.05 at 95% confidence interval were considered to be statistically significant. Results The overall resection rate was 21%. Although 55% of patients were deemed resectable on imaging, 61.8% were found unresectable intra-operatively due to vascular invasion or metastases. Most tumors (92%) were located in the pancreatic head, and 51% were stage III or IV. In multivariate analysis, only tumor size > 4 cm was significantly associated with irresectability (AOR = 0.054, 95% CI: 0.015–0.193, p < 0.001). Conclusion Despite favorable imaging, many patients are unresectable at surgery. Tumor size is an independent predictor of resectability. Enhanced diagnostic imaging is needed to improve preoperative assessment in low-resource settings. Pancreatic tumors surgical resection Resectability predictors CT scan Background Pancreatic tumors are among the most lethal malignancies globally, ranking 12th in incidence and 7th in mortality, and accounting for 4.6% of all cancer-related deaths (Sun et al., 2020 ; Lippi & Mattiuzzi, 2020 ). In Uganda, the Global Cancer Observatory (GLOBOCAN 2023) ranks pancreatic cancer 22nd in incidence and 17th in cancer-related deaths, with 290 new cases and 271 deaths reported. Records at the Upper GIT Unit of Mulago National Referral Hospital (MNRH) show a rising burden, with an average of six new cases admitted monthly. The overall 5-year survival for pancreatic tumors remains poor, ranging from 2% to 9% globally, regardless of income level (Pourshams et al., 2019 ). Surgical resection is the only potentially curative intervention and can raise the 5-year survival rate to approximately 17.5% (Bengtsson et al., 2020). However, only 20% of patients are eligible for resection at diagnosis, due to advanced local or metastatic disease (De Angelis et al., 2014 ; White & Lowy, 2017 ). The complexity of pancreatic surgery, coupled with its high perioperative risks (Jiang et al., 2019 ), necessitates thorough preoperative evaluation to select appropriate surgical candidates. Traditionally, resectability is assessed radiologically, primarily using contrast-enhanced CT with a positive predictive value of 75–86% (Somers & Bipat, 2017 ). This remains the most accessible tool in low-income countries such as Uganda. Internationally recognized frameworks such as the NCCN guidelines (Kato et al., 2021 ) and the Resectability Scoring System (Toesca et al., 2023 ) guide imaging-based evaluation. However, clinical and biochemical markers, including hemoglobin, albumin, CA 19 − 9, and CEA have also been shown to contribute meaningfully to resectability prediction (Chiang et al., 2012 ). Despite advances in diagnostics, resectability prediction remains imprecise. Studies show that nearly 50% of tumors deemed resectable preoperatively are found unresectable at surgery (Khattab et al., 2012 ). A pilot study at MNRH (unpublished) showed a resection rate below 10%, significantly lower than the global benchmark of 20%, suggesting a major gap in surgical outcomes. This study, therefore, aims to determine the resection rate and identify clinical, biochemical, and radiological predictors of resectability of pancreatic tumors at Mulago National Referral Hospital. The findings will help improve preoperative decision-making and patient outcomes in low-resource settings. Methods Study Design and Setting This was a retrospective cross-sectional study conducted at Mulago National Referral Hospital (MNRH) from January 2021 to January 2024. MNRH is Uganda’s largest tertiary and teaching hospital, affiliated with Makerere University College of Health Sciences. It has a bed capacity of about 1,500 and provides specialized surgical and medical services. Patients with pancreatic tumors are managed in the Upper Gastrointestinal and Pancreato-hepato-biliary Unit of the Directorate of Surgery. This ward has a capacity of 35 beds and admits an average of four pancreatic tumor cases monthly. Patients are referred through the surgical outpatient clinic, accident and emergency unit, or from the Uganda Cancer Institute. Diagnosis is based on triphasic abdominal CT scans performed at MNRH or peripheral facilities, with reports confirmed by MNRH radiologists. Elective pancreatic surgeries such as Whipple’s procedures and distal pancreatectomies are performed twice weekly, usually following tumor board review, with postoperative intensive care provided for a minimum of 72 hours. Study Population and Sampling This study was approved with waiver of consent by Makerere University School of Medicine Research and Ethics Committee (Mak-SOMREC 2024 − 1077). The study population comprised patients with pancreatic tumors admitted to MNRH between January 2021 and January 2024. Eligible records included patients with CT-confirmed pancreatic tumors managed in the Upper GI unit. Exclusion criteria were: refusal of surgery despite eligibility, concurrent malignancies, and previous pancreatic surgery. Sample size estimation using Cohen’s method yielded 215 participants; however, after adjusting for the finite population of 144 admissions in four years and allowing for missing records, the final required sample was 95 patient files. A consecutive sampling method was employed to obtain all eligible records until the target was reached. Study Procedure and Data Collection Names and in-patient numbers of patients with pancreatic tumors were retrieved from the Upper GI unit admission register. Patient files were then obtained from the records office and screened against eligibility criteria. Data were extracted using a structured tool capturing demographic characteristics, clinical symptoms (jaundice, abdominal pain, weight loss), biochemical parameters (hemoglobin, CA 19 − 9, CEA), radiological features (tumor size, TNM stage, vascular involvement, metastases), operative findings, and resectability status at surgery. Two trained research assistants collected the data under supervision of the principal investigator, with completeness and accuracy checked through double entry. Data Management and Statistical Analysis Data were entered into Microsoft Excel, cleaned, and exported to SPSS version 25 for analysis. Continuous variables were summarized as means with standard deviations if normally distributed, or medians with interquartile ranges if skewed. Categorical variables were summarized as frequencies and percentages. The primary outcome was resection rate, calculated as the proportion of patients undergoing tumor resection out of all those admitted with pancreatic tumors. Logistic regression analysis was used to assess clinical, biochemical, and radiological predictors of resectability. Variables with p-values < 0.20 at univariate analysis were included in multivariate logistic regression. Adjusted odds ratios with 95% confidence intervals were reported, and statistical significance was set at p < 0.05. Results Description of study participants and their clinical characteristics Participants were middle-aged, with a mean age of 57.1 ± 14.7 years . Symptom duration before presentation was prolonged: jaundice persisted for an average of 10.5 ± 8.9 weeks , abdominal pain for 16.1 ± 16.1 weeks , and weight loss for 15.1 ± 14.5 weeks . Laboratory findings showed marked hyperbilirubinemia (mean total bilirubin 257.7 µmol/L , direct bilirubin 188.7 µmol/L ), reflecting obstructive jaundice in most patients. The mean hemoglobin level was 10.4 ± 2.2 g/dL , indicating mild-to-moderate anemia. Tumor markers were frequently elevated, with CA 19 − 9 averaging 448.2 U/mL and CEA averaging 12.0 ng/mL , though both demonstrated wide variability. (Table 1 ) Table 1 Baseline characteristics of participants Variable N Mean ± SD Age (years) 100 57.1 ± 14.7 Duration of Jaundice (weeks) 100 10.5 ± 8.9 Duration of Abdominal Pain (weeks) 100 16.1 ± 16.1 Duration of Weight Loss (weeks) 100 15.1 ± 14.5 Total Bilirubin (µmol/L) 86 257.7 ± 187.8 Direct Bilirubin (µmol/L) 88 188.7 ± 132.7 Hemoglobin (g/dL) 100 10.4 ± 2.2 CEA (ng/mL) 71 12.0 ± 25.5 CA 19 − 9 (U/mL) 92 448.2 ± 422.1 In the categorical demographic and radiologic characteristics. The sex distribution was balanced ( 48% male, 52% female ). Tumors were predominantly located in the pancreatic head (92%) , with few in the body (7%) or tail (1%). Lymph node involvement was observed in 28.3% , and distant metastases in 20% of patients. Using Manchester stratification, 49% had early-stage disease (TNM I–II) , while 51% presented with late-stage disease (TNM III–IV) . Vascular involvement was frequent: SMA (23%) , celiac axis (15%) , SMV (11%) , portal vein (8%) , and CHA (3%) . These findings illustrate a predominance of locally advanced or metastatic tumors among patients evaluated at MNRH. (Table 2 ) Table 2 Participant characteristics Variable Category N (%) Sex Male 48 (48.0%) Female 52 (52.0%) Tumor Location Head 92 (92.0%) Body 7 (7.0%) Tail 1 (1.0%) Lymph Node Involvement Absent 71 (71.7%) Present 28 (28.3%) Metastasis Absent 80 (80.0%) Present 20 (20.0%) TNM Stage Early disease 49 (49.0%) Late disease 51(51.0%) Celiac Axis Involvement No 85 (85.0%) Yes 15 (15.0%) SMA Involvement No 77 (77.0%) Yes 23 (23.0%) CHA Involvement No 97 (97.0%) Yes 3 (3.0%) SMV Involvement No 89 (89.0%) Yes 11 (11.0%) PV Involvement No 92 (92.0%) Yes 8 (8.0%) Resection rates of pancreatic tumors at MNRH Out of 100 patients with pancreatic tumors, only 21 underwent surgical resection, yielding an overall resection rate of 21%. Preoperatively, 55 patients (55%) had been classified as resectable on CT imaging, but intraoperative findings revealed that 34 of these (61.8%) were in fact unresectable, mostly due to vascular invasion and previously undetected metastases. Resection rates varied across clinical and radiological variables. Patients with tumors ≤ 4 cm were more likely to undergo resection (62.5%) compared to those with tumors > 4 cm, where resection was rare (8%). Similarly, all patients with distant metastases were unresectable, giving a 0% resection rate in this subgroup, while patients without metastases had a resection rate of 26.3%. Among those with lymph node involvement, only 7% were resected compared to 25% in those without nodal spread. Tumor location also showed differences: resection was slightly more common in tumors of the pancreatic head (19.5%) compared to body/tail lesions (37.5%), although numbers were small. Patients with hemoglobin > 10 g/dL had higher resection rates (24.6%) than those below this threshold (15.4%), suggesting better surgical candidacy in less anemic patients. Univariate analysis of variables Differences in mean values between resected and non-resected patients were compared using the independent samples t -test and among the variables analyzed, only tumor size differed significantly between resected and non-resected patients. Resected patients had a mean tumor size of 3.6 cm compared to 6.0 cm in the unresected group (p < 0.001). Other parameters including age, duration of symptoms, bilirubin levels, hemoglobin, and tumor markers (CEA, CA 19 − 9) showed no significant differences between the two groups. (Table 3 ) Table 3 Differences in mean between resected and non-resected patients Variable Not Resected Mean ± SD Resected Mean ± SD Mean Difference p-value 95% CI of Difference Age (years) 57.9 ± 15.3 53.9 ± 11.9 3.92 0.278 –3.22, 11.06 Duration of Jaundice (weeks) 10.4 ± 8.8 10.6 ± 9.5 –0.19 0.932 –4.55, 4.17 Abdominal Pain Duration (weeks) 16.7 ± 17.0 13.7 ± 12.1 2.96 0.458 –4.91, 10.83 Weight Loss Duration (weeks) 15.2 ± 15.3 14.9 ± 11.5 0.30 0.935 –6.83, 7.42 Total Bilirubin (µmol/L) 258.0 ± 194.6 256.5 ± 164.3 1.49 0.976 –98.1, 101.0 Direct Bilirubin (µmol/L) 181.8 ± 129.4 213.7 ± 145.0 –31.86 0.357 –100.3, 36.5 Hemoglobin (g/dL) 10.2 ± 2.3 11.1 ± 1.7 –0.88 0.105 –1.95, 0.19 CEA (ng/mL) 12.4 ± 27.6 11.1 ± 19.3 1.29 0.852 –12.44, 15.02 CA 19 − 9 (U/mL) 458.3 ± 437.1 409.4 ± 367.0 48.94 0.655 –168.0, 265.9 Tumor Size (cm) 6.02 ± 2.16 3.61 ± 2.34 2.41 < 0.001 1.26, 3.57 . Further analysis assessed associations between patient and tumor characteristics and the likelihood of tumor resectability. Only three variables had p-values < 0.2 and were considered to have potential significant associations with resectability: tumor size, presence of metastases, and lymph node involvement. Notably, none of the patients with metastases underwent surgical resection, resulting in an odds ratio of zero for this group. (Table 4 ) Table 4 Predictors of resectability Predictor Category Resected (n) Un-resected (n) Crude Odds Ratio (95% CI) p-value Tumor Size ≤ 4 cm 15 9 Ref. — > 4 cm 6 69 0.052 (0.016–0.169) < 0.001 Lymph Node Involvement Not involved 18 53 Ref. — Involved 2 26 0.226 (0.049–1.051) 0.042 Metastasis Absent 21 59 Ref. — Present 0 20 Not estimable (0 events) 0.010 Tumor Location Not Head 3 5 Ref. — Head 18 74 2.467 (0.539–11.292) 0.232 Hemoglobin level Below 10g/dl 6 33 Ref. — Above 10g/dl 15 46 1.793 (0.629–5.110) 0.270 Multivariate Analysis for predictors of resectability In the multivariate analysis, variables with a p-value less than 0.2 in the univariate analysis were included in the model. These variables were tumor size (≤ 4 cm vs > 4 cm) with p < 0.001, lymph node involvement ( p = 0.141 ) , and tumor location (head vs non-head) with p = 0.115. Additionally, hemoglobin levels (< 10 g/dL vs ≥ 10 g/dL) were included despite a p-value of 0.285, due to their clinical relevance (Table 5 ) Table 5 Adjusted odds ratios for predictors of resectability Predictor Category Resectable (n) Unresectable (n) Adjusted OR (95% CI) p-value Tumor Location Head 19 71 1.00 (Reference) — Not Head 2 6 4.761 (0.683–33.187) 0.115 Hemoglobin 10g/dl 15 46 2.036 (0.553–7.494) 0.285 Lymph Node Involvement Absent 18 52 1.00 (Reference) — Present 2 26 0.242 (0.037–1.604) 0.141 Tumor Size 4cm 6 69 0.054 (0.015–0.193) < 0.001 In the multivariate model, tumor size emerged as the only independent predictor of resectability. Patients with tumors ≤ 4 cm were significantly more likely to undergo successful resection compared to those with tumors > 4 cm (AOR = 0.054; p 10 g/dl) and absence of lymph node involvement were associated with increased likelihood of resection. Tumor location outside the pancreatic head showed a trend toward lower resectability. Overall, these findings highlight tumor size as the most reliable determinant of resectability in this cohort. Discussion In this study, the overall resection rate of pancreatic tumors at Mulago National Referral Hospital (MNRH) was 21%. This finding lies within the global resection rate range of 15–25% reported in multiple international studies (De Angelis et al., 2014 ; White & Lowy, 2017 ). When compared with African data, our resection rate was notably higher than that reported in Kenya (7%) and Tanzania (6%) (Muchiri et al., 2024 ; Kivuyo & Akoko, 2022 ), but comparable to the 23% documented in Ethiopia (Dinagde & Abubeker, 2024 ). The relatively higher rate observed at MNRH can be explained by its position as a national referral and teaching hospital, where most complex hepatopancreaticobiliary cases are centralized and managed by more specialized surgeons, unlike in regional hospitals where limited surgical capacity and expertise may lower resection rates. Despite over half (55%) of the patients being classified as resectable preoperatively, more than 60% of these were deemed unresectable intraoperatively due to vascular involvement or previously undetected metastases. This high discrepancy between preoperative and intraoperative findings is consistent with (Khattab et al. 2012 ), who reported that 50% of patients initially judged resectable turned out irresectable during surgery. Such discrepancies are largely due to limitations in preoperative staging in resource-limited settings, where advanced imaging modalities such as PET scans, endoscopic ultrasound (EUS), diagnostic laparoscopy, and high-resolution MRI are unavailable. This underlines the importance of improving diagnostic pathways to avoid unnecessary laparotomies and associated morbidity. The mean age of patients in this study was 57.1 years, and the sex distribution was nearly equal. These findings are consistent with studies conducted in Saudi Arabia, Ethiopia, and East Africa, which also reported mean ages in the late 50s with no marked gender predominance (Chiang et al., 2012 ; Almadi et al., 2013 ; Muchiri et al., 2024 ). This reflects the epidemiological trend that pancreatic cancer is predominantly a disease of middle-aged and older adults, without strong sex predilection. Clinically, patients most frequently presented with jaundice, abdominal pain, and weight loss, which is expected given that the majority (92%) had pancreatic head tumors. These findings align with Tempero et al. ( 2010 ) and Almadi et al. ( 2013 ), who observed that tumors located in the head present earlier due to biliary obstruction, while tumors in the body or tail often remain asymptomatic until more advanced. The mean duration of symptoms before presentation was over 10 weeks, which demonstrates delayed health-seeking behavior and referral challenges in Uganda, similar to what was reported in Kenya (Muchiri et al., 2024 ). Biochemical evaluation revealed that most patients had anemia (mean hemoglobin 10.4 g/dL), consistent with findings by Ruiz-Tovar et al. (2010), who associated low hemoglobin with worse surgical outcomes. Although patients with hemoglobin ≥ 10 g/dL were more likely to undergo resection (24.6%) compared to those below 10 g/dL (15.4%), this did not reach statistical significance in multivariate analysis. This suggests that while anemia reflects poor baseline health, it may not independently influence resectability. Tumor markers were frequently elevated, with a mean CA 19 − 9 level of 448.2 U/mL. As in other studies (Mohamed et al., 2020 ; Almadi et al., 2013 ), CA 19 − 9 was not an independent predictor of resectability. Elevated levels likely reflect higher tumor burden or advanced disease, but they do not differentiate between resectable and unresectable disease. This underscores the fact that tumor markers should be interpreted cautiously and used more for prognosis and postoperative surveillance rather than surgical decision-making. Radiologically, lymph node involvement and metastases were seen in 28.3% and 20% of patients, respectively. In line with previous studies (Somers & Bipat, 2017 ; Vargas et al., 2004 ), patients with nodal disease or metastases were less likely to undergo resection. However, only tumor size remained statistically significant in the multivariate model. Nearly all patients with major vascular involvement (SMA, SMV, PV, CHA, CA) were unresectable, reaffirming vascular encasement as a critical determinant of surgical eligibility. Tumor size emerged as the strongest independent predictor of resectability. Patients with tumors > 4 cm were 95% less likely to undergo resection compared to those with smaller tumors (AOR 0.054, p < 0.001). This is consistent with evidence from Asia and Europe (Chiang et al., 2014 ; Hong et al., 2018 ), where larger tumor size consistently correlated with poor resectability. This may be because larger tumors are more likely to invade adjacent vasculature or metastasize before diagnosis. Conclusion The resection rate for pancreatic tumors at MNRH was 21%, comparable with global resection rates with tumor size < 4 cm being the most robust predictor of resectability. While CA 19 − 9, CEA, and hemoglobin levels showed clinical trends although they did not achieve statistical significance. Radiological limitations like lack of PET scan and ERCP led to a high intraoperative irresectability rate, emphasizing the need for integrated preoperative assessment tools in Uganda and other low-resource settings. Abbreviations AJCC: American Joint Committee on Cancer CA 19.9: Carbohydrate Antigen 19.9 CEA: Carcinoembryonic Antigen CT: Computer Tomography ERCP: Endoscopic Retrograde Cholangio-Pancreaticography EUS: Endoscopic Ultrasound GIT: Gactro-intestinal Tract GLOBOCAN: Global Cancer Observatory ICU: Intensive Care Unit MNRH: Mulago National Referral Hospital MRI: Magnetic Resonance Imaging NCCN: National Comprehensive Cancer Network PD: Pancreatico Duodenectomy PET: Positron Emission Tomography PP: Pancreatic Protocol PPV: Positive Predictive Value PT: Pancreatic Tumor SOMREC: School of Medicine Research and Ethics committee of Makerere University TNM: Tumor, Node, Metastasis CHA: Common Hepatic Artery SMA: Superior Mesenteric Artery P V: Portal Vein AHPBA Americas Hepato-Pancreato-Biliary Association GBD Global Burden of Disease HJ Hepaticojejunostomy Declarations Ethical Approval and Consent This study was approved with waiver of consent by Makerere University School of Medicine Research and Ethics Committee (Mak-SOMREC-2024-1077) and administrative clearance was obtained from Mulago National Referral Hospital Management (MHREC 2892). Clinical trial number Not applicable Consent for publication Not applicable Availability of data and materials The primary dataset supporting this study may be obtained from the corresponding author on request Competing interests The authors declare that they have no competing financial or non-financial interests Funding No external funding was obtained in this study Authors’ contributions K.G. conceptualized the study. K.G., K.B., and S.P. developed the methodology and conducted the investigation. K.B., .S.P., and K.G. drafted the original manuscript. K.G., O.P., and K.O. reviewed and edited the manuscript. O.P. and K.O. provided supervision. All authors read and approved the final manuscript. Acknowledgements We thank administration of Mulago National Referral Hospital for giving clearance for the study to be conducted in the institution. Appreciation goes to the supervisors for their guidance Authors’ Information K.G, MB ChB Resident, Department of Surgery, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda E-mail: [email protected] K.B Resident, Department of Surgery, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda E-mail: [email protected] S.P Resident, Department of Surgery, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda E-mail: [email protected] O.P, MB ChB – MUST, M. Med Surgery- MAK, FCS-ECSA, PGDip Med Educ , PhD Senior Lecturer, Department of Surgery, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda E-mail: [email protected] K.O, MB ChB- MAK, M. 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Treatment outcomes of pancreatic cancer patients in Kenya. ecancermedicalscience 2024;18. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7535609","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":544663114,"identity":"ddda69b4-7960-4414-8ed8-5a2d76b5800e","order_by":0,"name":"Godfrey Kikuba","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAklEQVRIiWNgGAWjYHACgw8ggo2HgQ1I2QDZjI0HCGgxnIHQUpEG0tJAnBYGsJYzh8FCeLXIuzdvbK6oOGzMx3PG7MHPtvN2a9sPA22psYnGacWZY4WNZ84cNmPj7TE37G27nbztTCJQy7G03Aacrsoxf9jYdtiGjZ/HTIIXqMXsAFALY8NhfFoMGxv/QbRI/m07l2x2/iF+LfISIC0NYIeZSfOcOWBndoOALQY8QL80HEs3ZuM5Vm4sU5GcYHYDaEsCHr/ItzdvbGyosTac35O87eEbAzt7s/PpDx98qLHBbcsBMNUMF0gEq0zAoRxsC8SsOriAPR7Fo2AUjIJRMEIBAJIBZihnSfgaAAAAAElFTkSuQmCC","orcid":"","institution":"Makerere University","correspondingAuthor":true,"prefix":"","firstName":"Godfrey","middleName":"","lastName":"Kikuba","suffix":""},{"id":544663115,"identity":"e01e215c-b222-42d0-b48c-68d3db8f99f2","order_by":1,"name":"Brian Kasagga","email":"","orcid":"","institution":"Makerere 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08:39:32","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":114072,"visible":true,"origin":"","legend":"","description":"","filename":"4b9e179a417342968f4efe9a7d36aac81structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7535609/v1/ff8b8f8f5d21cdd3fe26651c.xml"},{"id":96449011,"identity":"7e3cc2cf-3036-437e-9496-3014d521b74c","added_by":"auto","created_at":"2025-11-21 08:39:32","extension":"html","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":127530,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7535609/v1/527b647bb7330335fcf5ff0a.html"},{"id":96456925,"identity":"5d7f1309-b8de-4fb9-9dce-830724b90f84","added_by":"auto","created_at":"2025-11-21 10:08:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1033037,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7535609/v1/167af7f0-31ad-47c5-89af-6cb7b979accf.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eResection Rates and Predictors of Resectability of Pancreatic Tumors at Mulago Hospital, A Retrospective Cross Sectional Study\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003ePancreatic tumors are among the most lethal malignancies globally, ranking 12th in incidence and 7th in mortality, and accounting for 4.6% of all cancer-related deaths (Sun et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Lippi \u0026amp; Mattiuzzi, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). In Uganda, the Global Cancer Observatory (GLOBOCAN 2023) ranks pancreatic cancer 22nd in incidence and 17th in cancer-related deaths, with 290 new cases and 271 deaths reported. Records at the Upper GIT Unit of Mulago National Referral Hospital (MNRH) show a rising burden, with an average of six new cases admitted monthly.\u003c/p\u003e\u003cp\u003eThe overall 5-year survival for pancreatic tumors remains poor, ranging from 2% to 9% globally, regardless of income level (Pourshams et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Surgical resection is the only potentially curative intervention and can raise the 5-year survival rate to approximately 17.5% (Bengtsson et al., 2020). However, only 20% of patients are eligible for resection at diagnosis, due to advanced local or metastatic disease (De Angelis et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; White \u0026amp; Lowy, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). The complexity of pancreatic surgery, coupled with its high perioperative risks (Jiang et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), necessitates thorough preoperative evaluation to select appropriate surgical candidates.\u003c/p\u003e\u003cp\u003eTraditionally, resectability is assessed radiologically, primarily using contrast-enhanced CT with a positive predictive value of 75\u0026ndash;86% (Somers \u0026amp; Bipat, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). This remains the most accessible tool in low-income countries such as Uganda. Internationally recognized frameworks such as the NCCN guidelines (Kato et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) and the Resectability Scoring System (Toesca et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) guide imaging-based evaluation. However, clinical and biochemical markers, including hemoglobin, albumin, CA 19\u0026thinsp;\u0026minus;\u0026thinsp;9, and CEA have also been shown to contribute meaningfully to resectability prediction (Chiang et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2012\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eDespite advances in diagnostics, resectability prediction remains imprecise. Studies show that nearly 50% of tumors deemed resectable preoperatively are found unresectable at surgery (Khattab et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). A pilot study at MNRH (unpublished) showed a resection rate below 10%, significantly lower than the global benchmark of 20%, suggesting a major gap in surgical outcomes.\u003c/p\u003e\u003cp\u003eThis study, therefore, aims to determine the resection rate and identify clinical, biochemical, and radiological predictors of resectability of pancreatic tumors at Mulago National Referral Hospital. The findings will help improve preoperative decision-making and patient outcomes in low-resource settings.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design and Setting\u003c/h2\u003e\u003cp\u003eThis was a retrospective cross-sectional study conducted at Mulago National Referral Hospital (MNRH) from January 2021 to January 2024. MNRH is Uganda\u0026rsquo;s largest tertiary and teaching hospital, affiliated with Makerere University College of Health Sciences. It has a bed capacity of about 1,500 and provides specialized surgical and medical services.\u003c/p\u003e\u003cp\u003ePatients with pancreatic tumors are managed in the Upper Gastrointestinal and Pancreato-hepato-biliary Unit of the Directorate of Surgery. This ward has a capacity of 35 beds and admits an average of four pancreatic tumor cases monthly. Patients are referred through the surgical outpatient clinic, accident and emergency unit, or from the Uganda Cancer Institute. Diagnosis is based on triphasic abdominal CT scans performed at MNRH or peripheral facilities, with reports confirmed by MNRH radiologists. Elective pancreatic surgeries such as Whipple\u0026rsquo;s procedures and distal pancreatectomies are performed twice weekly, usually following tumor board review, with postoperative intensive care provided for a minimum of 72 hours.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy Population and Sampling\u003c/h3\u003e\n\u003cp\u003e This study was approved with waiver of consent by Makerere University School of Medicine Research and Ethics Committee (Mak-SOMREC 2024\u0026thinsp;\u0026minus;\u0026thinsp;1077). The study population comprised patients with pancreatic tumors admitted to MNRH between January 2021 and January 2024. Eligible records included patients with CT-confirmed pancreatic tumors managed in the Upper GI unit. Exclusion criteria were: refusal of surgery despite eligibility, concurrent malignancies, and previous pancreatic surgery.\u003c/p\u003e\u003cp\u003e Sample size estimation using Cohen\u0026rsquo;s method yielded 215 participants; however, after adjusting for the finite population of 144 admissions in four years and allowing for missing records, the final required sample was 95 patient files. A consecutive sampling method was employed to obtain all eligible records until the target was reached.\u003c/p\u003e\n\u003ch3\u003eStudy Procedure and Data Collection\u003c/h3\u003e\n\u003cp\u003eNames and in-patient numbers of patients with pancreatic tumors were retrieved from the Upper GI unit admission register. Patient files were then obtained from the records office and screened against eligibility criteria. Data were extracted using a structured tool capturing demographic characteristics, clinical symptoms (jaundice, abdominal pain, weight loss), biochemical parameters (hemoglobin, CA 19\u0026thinsp;\u0026minus;\u0026thinsp;9, CEA), radiological features (tumor size, TNM stage, vascular involvement, metastases), operative findings, and resectability status at surgery. Two trained research assistants collected the data under supervision of the principal investigator, with completeness and accuracy checked through double entry.\u003c/p\u003e\n\u003ch3\u003eData Management and Statistical Analysis\u003c/h3\u003e\n\u003cp\u003eData were entered into Microsoft Excel, cleaned, and exported to SPSS version 25 for analysis. Continuous variables were summarized as means with standard deviations if normally distributed, or medians with interquartile ranges if skewed. Categorical variables were summarized as frequencies and percentages.\u003c/p\u003e\u003cp\u003eThe primary outcome was resection rate, calculated as the proportion of patients undergoing tumor resection out of all those admitted with pancreatic tumors. Logistic regression analysis was used to assess clinical, biochemical, and radiological predictors of resectability. Variables with p-values\u0026thinsp;\u0026lt;\u0026thinsp;0.20 at univariate analysis were included in multivariate logistic regression. Adjusted odds ratios with 95% confidence intervals were reported, and statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eDescription of study participants and their clinical characteristics\u003c/h2\u003e\u003cp\u003eParticipants were middle-aged, with a mean age of \u003cb\u003e57.1\u0026thinsp;\u0026plusmn;\u0026thinsp;14.7 years\u003c/b\u003e. Symptom duration before presentation was prolonged: jaundice persisted for an average of \u003cb\u003e10.5\u0026thinsp;\u0026plusmn;\u0026thinsp;8.9 weeks\u003c/b\u003e, abdominal pain for \u003cb\u003e16.1\u0026thinsp;\u0026plusmn;\u0026thinsp;16.1 weeks\u003c/b\u003e, and weight loss for \u003cb\u003e15.1\u0026thinsp;\u0026plusmn;\u0026thinsp;14.5 weeks\u003c/b\u003e. Laboratory findings showed \u003cb\u003emarked hyperbilirubinemia\u003c/b\u003e (mean total bilirubin \u003cb\u003e257.7 \u0026micro;mol/L\u003c/b\u003e, direct bilirubin \u003cb\u003e188.7 \u0026micro;mol/L\u003c/b\u003e), reflecting obstructive jaundice in most patients. The mean hemoglobin level was \u003cb\u003e10.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2 g/dL\u003c/b\u003e, indicating mild-to-moderate anemia. Tumor markers were frequently elevated, with \u003cb\u003eCA 19\u0026thinsp;\u0026minus;\u0026thinsp;9 averaging 448.2 U/mL\u003c/b\u003e and \u003cb\u003eCEA averaging 12.0 ng/mL\u003c/b\u003e, though both demonstrated wide variability. (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBaseline characteristics of participants\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e57.1\u0026thinsp;\u0026plusmn;\u0026thinsp;14.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDuration of Jaundice (weeks)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e10.5\u0026thinsp;\u0026plusmn;\u0026thinsp;8.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDuration of Abdominal Pain (weeks)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e16.1\u0026thinsp;\u0026plusmn;\u0026thinsp;16.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDuration of Weight Loss (weeks)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e15.1\u0026thinsp;\u0026plusmn;\u0026thinsp;14.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal Bilirubin (\u0026micro;mol/L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e257.7\u0026thinsp;\u0026plusmn;\u0026thinsp;187.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDirect Bilirubin (\u0026micro;mol/L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e188.7\u0026thinsp;\u0026plusmn;\u0026thinsp;132.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHemoglobin (g/dL)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e10.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCEA (ng/mL)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e12.0\u0026thinsp;\u0026plusmn;\u0026thinsp;25.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCA 19\u0026thinsp;\u0026minus;\u0026thinsp;9 (U/mL)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e448.2\u0026thinsp;\u0026plusmn;\u0026thinsp;422.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eIn the categorical demographic and radiologic characteristics. The sex distribution was balanced (\u003cb\u003e48% male, 52% female\u003c/b\u003e). Tumors were predominantly located in the \u003cb\u003epancreatic head (92%)\u003c/b\u003e, with few in the body (7%) or tail (1%). \u003cb\u003eLymph node involvement\u003c/b\u003e was observed in \u003cb\u003e28.3%\u003c/b\u003e, and \u003cb\u003edistant metastases\u003c/b\u003e in \u003cb\u003e20%\u003c/b\u003e of patients. Using Manchester stratification, \u003cb\u003e49%\u003c/b\u003e had \u003cb\u003eearly-stage disease (TNM I\u0026ndash;II)\u003c/b\u003e, while \u003cb\u003e51%\u003c/b\u003e presented with \u003cb\u003elate-stage disease (TNM III\u0026ndash;IV)\u003c/b\u003e. Vascular involvement was frequent: \u003cb\u003eSMA (23%)\u003c/b\u003e, \u003cb\u003eceliac axis (15%)\u003c/b\u003e, \u003cb\u003eSMV (11%)\u003c/b\u003e, \u003cb\u003eportal vein (8%)\u003c/b\u003e, and \u003cb\u003eCHA (3%)\u003c/b\u003e. These findings illustrate a predominance of locally advanced or metastatic tumors among patients evaluated at MNRH. (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eParticipant characteristics\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e48 (48.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e52 (52.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTumor Location\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHead\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e92 (92.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBody\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7 (7.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTail\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1 (1.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLymph Node Involvement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAbsent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e71 (71.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePresent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e28 (28.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMetastasis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAbsent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e80 (80.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePresent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20 (20.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTNM Stage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEarly disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e49 (49.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLate disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e51(51.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCeliac Axis Involvement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e85 (85.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15 (15.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSMA Involvement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e77 (77.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e23 (23.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCHA Involvement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e97 (97.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3 (3.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSMV Involvement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e89 (89.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11 (11.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePV Involvement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e92 (92.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8 (8.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eResection rates of pancreatic tumors at MNRH\u003c/h3\u003e\n\u003cp\u003eOut of 100 patients with pancreatic tumors, only 21 underwent surgical resection, yielding an overall resection rate of 21%. Preoperatively, 55 patients (55%) had been classified as resectable on CT imaging, but intraoperative findings revealed that 34 of these (61.8%) were in fact unresectable, mostly due to vascular invasion and previously undetected metastases.\u003c/p\u003e\u003cp\u003eResection rates varied across clinical and radiological variables. Patients with tumors\u0026thinsp;\u0026le;\u0026thinsp;4 cm were more likely to undergo resection (62.5%) compared to those with tumors\u0026thinsp;\u0026gt;\u0026thinsp;4 cm, where resection was rare (8%). Similarly, all patients with distant metastases were unresectable, giving a 0% resection rate in this subgroup, while patients without metastases had a resection rate of 26.3%. Among those with lymph node involvement, only 7% were resected compared to 25% in those without nodal spread. Tumor location also showed differences: resection was slightly more common in tumors of the pancreatic head (19.5%) compared to body/tail lesions (37.5%), although numbers were small. Patients with hemoglobin\u0026thinsp;\u0026gt;\u0026thinsp;10 g/dL had higher resection rates (24.6%) than those below this threshold (15.4%), suggesting better surgical candidacy in less anemic patients.\u003c/p\u003e\n\u003ch3\u003eUnivariate analysis of variables\u003c/h3\u003e\n\u003cp\u003eDifferences in mean values between resected and non-resected patients were compared using the independent samples \u003cem\u003et\u003c/em\u003e-test and among the variables analyzed, only tumor size differed significantly between resected and non-resected patients. Resected patients had a mean tumor size of 3.6 cm compared to 6.0 cm in the unresected group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Other parameters including age, duration of symptoms, bilirubin levels, hemoglobin, and tumor markers (CEA, CA 19\u0026thinsp;\u0026minus;\u0026thinsp;9) showed no significant differences between the two groups. (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDifferences in mean between resected and non-resected patients\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNot Resected \u003cem\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eResected \u003cem\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMean Difference\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e95% CI of Difference\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e57.9\u0026thinsp;\u0026plusmn;\u0026thinsp;15.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e53.9\u0026thinsp;\u0026plusmn;\u0026thinsp;11.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.278\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;3.22, 11.06\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDuration of Jaundice (weeks)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e10.4\u0026thinsp;\u0026plusmn;\u0026thinsp;8.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e10.6\u0026thinsp;\u0026plusmn;\u0026thinsp;9.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026ndash;0.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.932\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;4.55, 4.17\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbdominal Pain Duration (weeks)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e16.7\u0026thinsp;\u0026plusmn;\u0026thinsp;17.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e13.7\u0026thinsp;\u0026plusmn;\u0026thinsp;12.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.458\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;4.91, 10.83\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWeight Loss Duration (weeks)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e15.2\u0026thinsp;\u0026plusmn;\u0026thinsp;15.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e14.9\u0026thinsp;\u0026plusmn;\u0026thinsp;11.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.935\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;6.83, 7.42\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal Bilirubin (\u0026micro;mol/L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e258.0\u0026thinsp;\u0026plusmn;\u0026thinsp;194.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e256.5\u0026thinsp;\u0026plusmn;\u0026thinsp;164.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.976\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;98.1, 101.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDirect Bilirubin (\u0026micro;mol/L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e181.8\u0026thinsp;\u0026plusmn;\u0026thinsp;129.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e213.7\u0026thinsp;\u0026plusmn;\u0026thinsp;145.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026ndash;31.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.357\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;100.3, 36.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHemoglobin (g/dL)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e10.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e11.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026ndash;0.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.105\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;1.95, 0.19\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCEA (ng/mL)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e12.4\u0026thinsp;\u0026plusmn;\u0026thinsp;27.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e11.1\u0026thinsp;\u0026plusmn;\u0026thinsp;19.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.852\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;12.44, 15.02\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCA 19\u0026thinsp;\u0026minus;\u0026thinsp;9 (U/mL)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e458.3\u0026thinsp;\u0026plusmn;\u0026thinsp;437.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e409.4\u0026thinsp;\u0026plusmn;\u0026thinsp;367.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e48.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.655\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;168.0, 265.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTumor Size (cm)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e6.02\u0026thinsp;\u0026plusmn;\u0026thinsp;2.16\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e3.61\u0026thinsp;\u0026plusmn;\u0026thinsp;2.34\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e2.41\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e1.26, 3.57\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e.\u003c/p\u003e\u003cp\u003eFurther analysis assessed associations between patient and tumor characteristics and the likelihood of tumor resectability. Only three variables had p-values\u0026thinsp;\u0026lt;\u0026thinsp;0.2 and were considered to have potential significant associations with resectability: tumor size, presence of metastases, and lymph node involvement. Notably, none of the patients with metastases underwent surgical resection, resulting in an odds ratio of zero for this group. (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePredictors of resectability\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePredictor\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eResected (n)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eUn-resected (n)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCrude Odds Ratio (95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTumor Size\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;4 cm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;4 cm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.052 (0.016\u0026ndash;0.169)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLymph Node Involvement\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNot involved\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInvolved\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.226 (0.049\u0026ndash;1.051)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.042\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMetastasis\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAbsent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePresent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNot estimable (0 events)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.010\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTumor Location\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNot Head\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHead\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.467 (0.539\u0026ndash;11.292)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.232\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHemoglobin level\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBelow 10g/dl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eRef.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAbove\u003c/p\u003e\u003cp\u003e10g/dl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.793 (0.629\u0026ndash;5.110)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.270\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eMultivariate Analysis for predictors of resectability\u003c/h2\u003e\u003cp\u003eIn the multivariate analysis, variables with a p-value less than 0.2 in the univariate analysis were included in the model. These variables were tumor size (\u0026le;\u0026thinsp;4 cm vs\u0026thinsp;\u0026gt;\u0026thinsp;4 cm) with p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, lymph node involvement \u003cb\u003e(\u003c/b\u003ep\u0026thinsp;=\u0026thinsp;0.141\u003cb\u003e)\u003c/b\u003e, and tumor location (head vs non-head) with p\u0026thinsp;=\u0026thinsp;0.115. Additionally, hemoglobin levels (\u0026lt;\u0026thinsp;10 g/dL vs\u0026thinsp;\u0026ge;\u0026thinsp;10 g/dL) were included despite a p-value of 0.285, due to their clinical relevance (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAdjusted odds ratios for predictors of resectability\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePredictor\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eResectable (n)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eUnresectable (n)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAdjusted OR (95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTumor Location\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHead\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.00 (Reference)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNot Head\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.761 (0.683\u0026ndash;33.187)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.115\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHemoglobin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;10g/dl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.00 (Reference)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;10g/dl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.036 (0.553\u0026ndash;7.494)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.285\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLymph Node Involvement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAbsent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.00 (Reference)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePresent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.242 (0.037\u0026ndash;1.604)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.141\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTumor Size\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;4cm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.00 (Reference)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e\u0026mdash;\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;4cm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.054 (0.015\u0026ndash;0.193)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eIn the multivariate model, tumor size emerged as the only independent predictor of resectability. Patients with tumors\u0026thinsp;\u0026le;\u0026thinsp;4 cm were significantly more likely to undergo successful resection compared to those with tumors\u0026thinsp;\u0026gt;\u0026thinsp;4 cm (AOR\u0026thinsp;=\u0026thinsp;0.054; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Although not statistically significant, higher hemoglobin levels (\u0026gt;\u0026thinsp;10 g/dl) and absence of lymph node involvement were associated with increased likelihood of resection. Tumor location outside the pancreatic head showed a trend toward lower resectability. Overall, these findings highlight tumor size as the most reliable determinant of resectability in this cohort.\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, the overall resection rate of pancreatic tumors at Mulago National Referral Hospital (MNRH) was 21%. This finding lies within the global resection rate range of 15\u0026ndash;25% reported in multiple international studies (De Angelis et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; White \u0026amp; Lowy, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). When compared with African data, our resection rate was notably higher than that reported in Kenya (7%) and Tanzania (6%) (Muchiri et al., \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Kivuyo \u0026amp; Akoko, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), but comparable to the 23% documented in Ethiopia (Dinagde \u0026amp; Abubeker, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). The relatively higher rate observed at MNRH can be explained by its position as a national referral and teaching hospital, where most complex hepatopancreaticobiliary cases are centralized and managed by more specialized surgeons, unlike in regional hospitals where limited surgical capacity and expertise may lower resection rates.\u003c/p\u003e\u003cp\u003eDespite over half (55%) of the patients being classified as resectable preoperatively, more than 60% of these were deemed unresectable intraoperatively due to vascular involvement or previously undetected metastases. This high discrepancy between preoperative and intraoperative findings is consistent with (Khattab et al. \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2012\u003c/span\u003e), who reported that 50% of patients initially judged resectable turned out irresectable during surgery. Such discrepancies are largely due to limitations in preoperative staging in resource-limited settings, where advanced imaging modalities such as PET scans, endoscopic ultrasound (EUS), diagnostic laparoscopy, and high-resolution MRI are unavailable. This underlines the importance of improving diagnostic pathways to avoid unnecessary laparotomies and associated morbidity.\u003c/p\u003e\u003cp\u003eThe mean age of patients in this study was 57.1 years, and the sex distribution was nearly equal. These findings are consistent with studies conducted in Saudi Arabia, Ethiopia, and East Africa, which also reported mean ages in the late 50s with no marked gender predominance (Chiang et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Almadi et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Muchiri et al., \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). This reflects the epidemiological trend that pancreatic cancer is predominantly a disease of middle-aged and older adults, without strong sex predilection.\u003c/p\u003e\u003cp\u003eClinically, patients most frequently presented with jaundice, abdominal pain, and weight loss, which is expected given that the majority (92%) had pancreatic head tumors. These findings align with Tempero et al. (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2010\u003c/span\u003e) and Almadi et al. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2013\u003c/span\u003e), who observed that tumors located in the head present earlier due to biliary obstruction, while tumors in the body or tail often remain asymptomatic until more advanced. The mean duration of symptoms before presentation was over 10 weeks, which demonstrates delayed health-seeking behavior and referral challenges in Uganda, similar to what was reported in Kenya (Muchiri et al., \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eBiochemical evaluation revealed that most patients had anemia (mean hemoglobin 10.4 g/dL), consistent with findings by Ruiz-Tovar et al. (2010), who associated low hemoglobin with worse surgical outcomes. Although patients with hemoglobin\u0026thinsp;\u0026ge;\u0026thinsp;10 g/dL were more likely to undergo resection (24.6%) compared to those below 10 g/dL (15.4%), this did not reach statistical significance in multivariate analysis. This suggests that while anemia reflects poor baseline health, it may not independently influence resectability.\u003c/p\u003e\u003cp\u003eTumor markers were frequently elevated, with a mean CA 19\u0026thinsp;\u0026minus;\u0026thinsp;9 level of 448.2 U/mL. As in other studies (Mohamed et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Almadi et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2013\u003c/span\u003e), CA 19\u0026thinsp;\u0026minus;\u0026thinsp;9 was not an independent predictor of resectability. Elevated levels likely reflect higher tumor burden or advanced disease, but they do not differentiate between resectable and unresectable disease. This underscores the fact that tumor markers should be interpreted cautiously and used more for prognosis and postoperative surveillance rather than surgical decision-making.\u003c/p\u003e\u003cp\u003eRadiologically, lymph node involvement and metastases were seen in 28.3% and 20% of patients, respectively. In line with previous studies (Somers \u0026amp; Bipat, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Vargas et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2004\u003c/span\u003e), patients with nodal disease or metastases were less likely to undergo resection. However, only tumor size remained statistically significant in the multivariate model. Nearly all patients with major vascular involvement (SMA, SMV, PV, CHA, CA) were unresectable, reaffirming vascular encasement as a critical determinant of surgical eligibility.\u003c/p\u003e\u003cp\u003eTumor size emerged as the strongest independent predictor of resectability. Patients with tumors\u0026thinsp;\u0026gt;\u0026thinsp;4 cm were 95% less likely to undergo resection compared to those with smaller tumors (AOR 0.054, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This is consistent with evidence from Asia and Europe (Chiang et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Hong et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), where larger tumor size consistently correlated with poor resectability. This may be because larger tumors are more likely to invade adjacent vasculature or metastasize before diagnosis.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe resection rate for pancreatic tumors at MNRH was 21%, comparable with global resection rates with tumor size\u0026thinsp;\u0026lt;\u0026thinsp;4 cm being the most robust predictor of resectability. While CA 19\u0026thinsp;\u0026minus;\u0026thinsp;9, CEA, and hemoglobin levels showed clinical trends although they did not achieve statistical significance. Radiological limitations like lack of PET scan and ERCP led to a high intraoperative irresectability rate, emphasizing the need for integrated preoperative assessment tools in Uganda and other low-resource settings.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAJCC:\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;American\u0026nbsp;Joint\u0026nbsp;Committee\u0026nbsp;on\u0026nbsp;Cancer\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCA 19.9:\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Carbohydrate Antigen 19.9\u003c/p\u003e\n\u003cp\u003eCEA: Carcinoembryonic Antigen\u003c/p\u003e\n\u003cp\u003eCT: Computer Tomography\u003c/p\u003e\n\u003cp\u003eERCP: Endoscopic Retrograde Cholangio-Pancreaticography\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;EUS:\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Endoscopic Ultrasound\u003c/p\u003e\n\u003cp\u003eGIT: Gactro-intestinal Tract GLOBOCAN: Global Cancer Observatory\u003c/p\u003e\n\u003cp\u003eICU: Intensive Care Unit\u003c/p\u003e\n\u003cp\u003eMNRH: Mulago National Referral Hospital MRI: Magnetic Resonance Imaging\u003c/p\u003e\n\u003cp\u003eNCCN: National Comprehensive Cancer Network\u003c/p\u003e\n\u003cp\u003ePD: Pancreatico Duodenectomy\u003c/p\u003e\n\u003cp\u003ePET:\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Positron\u0026nbsp;Emission\u0026nbsp;Tomography PP: Pancreatic Protocol\u003c/p\u003e\n\u003cp\u003ePPV: Positive Predictive Value\u003c/p\u003e\n\u003cp\u003ePT: Pancreatic Tumor\u003c/p\u003e\n\u003cp\u003eSOMREC: School of Medicine Research and Ethics committee of Makerere University\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTNM:\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Tumor, Node, Metastasis\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCHA: \u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Common Hepatic Artery\u003c/p\u003e\n\u003cp\u003eSMA: \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Superior \u0026nbsp; \u0026nbsp;Mesenteric Artery\u003c/p\u003e\n\u003cp\u003eP V:\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Portal Vein\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAHPBA\u003c/strong\u003e\u0026nbsp; Americas Hepato-Pancreato-Biliary Association\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGBD\u003c/strong\u003e\u0026nbsp; Global Burden of Disease\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHJ\u003c/strong\u003e\u0026nbsp; Hepaticojejunostomy\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eEthical\u0026nbsp;Approval and Consent\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved with waiver of consent by Makerere University School of Medicine Research and Ethics Committee (Mak-SOMREC-2024-1077) and administrative clearance was obtained from Mulago National Referral Hospital Management (MHREC 2892).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eClinical trial number\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsent\u0026nbsp;for publication\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAvailability\u0026nbsp;of data\u0026nbsp;and materials\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe primary dataset supporting this study may be obtained from the corresponding author on request\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCompeting\u0026nbsp;interests\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe\u0026nbsp;authors declare\u0026nbsp;that\u0026nbsp;they\u0026nbsp;have\u0026nbsp;no\u0026nbsp;competing\u0026nbsp;financial or\u0026nbsp;non-financial interests\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNo\u0026nbsp;external\u0026nbsp;funding\u0026nbsp;was\u0026nbsp;obtained\u0026nbsp;in\u0026nbsp;this study\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthors\u0026rsquo; contributions\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eK.G. conceptualized the study. K.G., K.B., and S.P. developed the methodology and conducted the investigation. K.B., .S.P., and K.G. drafted the original manuscript. K.G., O.P., and K.O. reviewed and edited the manuscript. O.P. and K.O. provided supervision. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003cem\u003e\u003cbr\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe\u0026nbsp;thank\u0026nbsp;administration\u0026nbsp;of\u0026nbsp;Mulago\u0026nbsp;National\u0026nbsp;Referral\u0026nbsp;Hospital\u0026nbsp;for giving\u0026nbsp;clearance\u0026nbsp;for\u0026nbsp;the\u0026nbsp;study to be conducted in the institution.\u003c/p\u003e\n\u003cp\u003eAppreciation goes\u0026nbsp;to\u0026nbsp;the supervisors\u0026nbsp;for\u0026nbsp;their guidance\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthors\u0026rsquo; Information\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eK.G, MB ChB\u003c/p\u003e\n\u003cp\u003eResident,\u0026nbsp;Department\u0026nbsp;of\u0026nbsp;Surgery,\u0026nbsp;School\u0026nbsp;of\u0026nbsp;Medicine,\u0026nbsp;College\u0026nbsp;of\u0026nbsp;Health\u0026nbsp;Sciences,\u0026nbsp;Makerere University, Kampala, Uganda\u003c/p\u003e\n\u003cp\u003eE-mail: [email protected]\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eK.B\u003c/p\u003e\n\u003cp\u003eResident,\u0026nbsp;Department\u0026nbsp;of\u0026nbsp;Surgery,\u0026nbsp;School\u0026nbsp;of\u0026nbsp;Medicine,\u0026nbsp;College\u0026nbsp;of\u0026nbsp;Health\u0026nbsp;Sciences,\u0026nbsp;Makerere University, Kampala, Uganda\u003c/p\u003e\n\u003cp\u003eE-mail: [email protected]\u003c/p\u003e\n\u003cp\u003eS.P\u003c/p\u003e\n\u003cp\u003eResident,\u0026nbsp;Department\u0026nbsp;of\u0026nbsp;Surgery,\u0026nbsp;School\u0026nbsp;of\u0026nbsp;Medicine,\u0026nbsp;College\u0026nbsp;of\u0026nbsp;Health\u0026nbsp;Sciences,\u0026nbsp;Makerere University, Kampala, Uganda\u003c/p\u003e\n\u003cp\u003eE-mail: [email protected]\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eO.P, MB ChB \u0026ndash; MUST, M. Med Surgery- MAK, FCS-ECSA, PGDip Med Educ , PhD\u003c/p\u003e\n\u003cp\u003eSenior\u0026nbsp;Lecturer,\u0026nbsp;Department\u0026nbsp;of\u0026nbsp;Surgery,\u0026nbsp;School\u0026nbsp;of\u0026nbsp;Medicine,\u0026nbsp;College\u0026nbsp;of\u0026nbsp;Health\u0026nbsp;Sciences,\u0026nbsp;Makerere University, Kampala, Uganda\u003c/p\u003e\n\u003cp\u003eE-mail:\u0026nbsp;[email protected]\u003c/p\u003e\n\u003cp\u003eK.O, MB ChB- MAK, M. Med Surgery \u0026ndash; MAK, FCS-ECSA, FMAS and DMAS, Fellow HPB Surgery, PhD\u003c/p\u003e\n\u003cp\u003eSenior\u0026nbsp;Lecturer,\u0026nbsp;Department\u0026nbsp;of\u0026nbsp;Surgery,\u0026nbsp;School\u0026nbsp;of\u0026nbsp;Medicine,\u0026nbsp;College\u0026nbsp;of\u0026nbsp;Health\u0026nbsp;Sciences,\u0026nbsp;Makerere University, Kampala, Uganda\u003c/p\u003e\n\u003cp\u003eUganda E-mail: [email protected]\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAlmadi MA, Alharbi O, Aljebreen AM, et al. 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Advancing complex hepato-pancreato-biliary surgery in Uganda: challenges and outcomes. World J Surg. 2024.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eModolell I, Guarner L, Malagelada JR. Vagaries of clinical presentation of pancreatic and biliary tract cancer. Ann Oncol. 1999;10(Suppl 2):S82\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMohamed A, Abdelghany H, Saad M. The Diagnostic Value of CA19.9 in Predicting Resectability. Med J Cairo Univ. 2020;88(Sep):1743\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePark SJ, Lee JM, Choi JY, et al. Preoperative resectability assessment by CT focusing on SMA/SMV branch invasion. Eur Radiol. 2021;31:6889\u0026ndash;97.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePorta M, Fabregat X, Malats N, et al. Symptoms at presentation and tumor site/stage in pancreatic cancer. 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BMC Surg. 2024;24(1):223.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHuang L, Jansen L, Balavarca Y, et al. Resection of pancreatic cancer in Europe/USA. Gut. 2019;68(1):130\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKivuyo NE, Akoko LO. Diagnosis and management of pancreatic masses in low-resource settings. Ann Pancreat Cancer 2022;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMuchiri SW, Ooko F, Githaiga J et al. Treatment outcomes of pancreatic cancer patients in Kenya. ecancermedicalscience 2024;18.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Pancreatic tumors; surgical resection, Resectability predictors, CT scan","lastPublishedDoi":"10.21203/rs.3.rs-7535609/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7535609/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003ePancreatic tumors are among the most lethal malignancies globally, with surgical resection being the only curative option. However, in low-income countries, most patients present at advanced stages, limiting surgical eligibility. Accurate preoperative prediction of resectability is essential for effective surgical planning. This study evaluated clinical, biochemical, and radiological predictors of pancreatic tumor resectability at Mulago National Referral Hospital (MNRH).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eWe conducted a retrospective cross-sectional study of 100 patients diagnosed with pancreatic tumors between January 2021 and December 2024. Demographic, clinical, biochemical, and radiological data were collected. Resection rates were calculated. Associations between independent variables and resectability were first explored using independent-samples t-tests and crude odds ratios. Predictors were then assessed with univariate and multivariate logistic regression models to obtain adjusted odds ratios. P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 at 95% confidence interval were considered to be statistically significant.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe overall resection rate was 21%. Although 55% of patients were deemed resectable on imaging, 61.8% were found unresectable intra-operatively due to vascular invasion or metastases. Most tumors (92%) were located in the pancreatic head, and 51% were stage III or IV. In multivariate analysis, only tumor size\u0026thinsp;\u0026gt;\u0026thinsp;4 cm was significantly associated with irresectability (AOR\u0026thinsp;=\u0026thinsp;0.054, 95% CI: 0.015\u0026ndash;0.193, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eDespite favorable imaging, many patients are unresectable at surgery. Tumor size is an independent predictor of resectability. Enhanced diagnostic imaging is needed to improve preoperative assessment in low-resource settings.\u003c/p\u003e","manuscriptTitle":"Resection Rates and Predictors of Resectability of Pancreatic Tumors at Mulago Hospital, A Retrospective Cross Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-21 08:39:27","doi":"10.21203/rs.3.rs-7535609/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b0352dae-45c6-4662-a06e-46b6e44619c0","owner":[],"postedDate":"November 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-21T08:39:27+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-21 08:39:27","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7535609","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7535609","identity":"rs-7535609","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}