Surgical and Palliative Treatment of Pancreatic Adenocarcinoma in the Yemeni Conflict: A Retrospective Cohort Study

Ahmed Ateik; Saif Ghabisha; Saleh Al-wageeh; Qasem Alyhari; Faisal Ahmed; Tofik Almekhlafi; Ali Almassaudi; Faris Alhajami

doi:10.31557/APJCC.2026.11.6.873

Authors

Ahmed Ateik Department of Surgery, Faculty of Medicine, 21 September University for Medical and Applied Sciences, Sana’a, Yemen.
Saif Ghabisha Department of Surgery, Faculty of Medicine, 21 September University for Medical and Applied Sciences, Sana’a, Yemen.
Saleh Al-wageeh Department of Surgery, Faculty of Medicine, 21 September University for Medical and Applied Sciences, Sana’a, Yemen.
Qasem Alyhari Department of Surgery, Faculty of Medicine, Ibb University, Ibb, Yemen.
Faisal Ahmed Department of Urology, Faculty of Medicine, Ibb University, Ibb, Yemen.
Tofik Almekhlafi Department of Surgery, Faculty of Medicine, 21 September University for Medical and Applied Sciences, Sana’a, Yemen.
Ali Almassaudi Department of Surgery, Faculty of Medicine, 21 September University for Medical and Applied Sciences, Sana’a, Yemen.
Faris Alhajami Department of Surgery, Faculty of Medicine, 21 September University for Medical and Applied Sciences, Sana’a, Yemen.

DOI:

https://doi.org/10.31557/APJCC.2026.11.6.873

Keywords:

Pancreatic Cancer; Pancreaticoduodenectomy; Blumgart Anastomosis; Conflict Medicine; Global Surgery; Yemen; Palliative Care; Surgical Outcomes.

Abstract

Introduction: Pancreatic cancer is a highly aggressive malignancy with poor survival rates. In Yemen, prolonged war and economic blockade have acted as major additional stressors within a multi-hit aetiological framework, accelerating disease progression and straining healthcare delivery. The Whipple procedure can be curative but is associated with high postoperative morbidity, requiring modern surgical innovations to succeed in resource-limited settings. This study aimed to assess the realities and outcomes of managing pancreatic adenocarcinoma in this complex humanitarian crisis.

Materials and Methods: A retrospective, multi-centre cohort study was conducted across five tertiary hospitals in Sana’a, Yemen. All consecutive patients with pancreatic adenocarcinoma who underwent surgery or dedicated palliative intervention from March 2015 to February 2025 were included. Demographic, diagnostic, and treatment data, as well as 30-day outcomes, were analysed.

Results: Of 487 records screened, 224 patients (mean age 55.4±10.2 years; 80.4% male) were included. Major risk factors were smoking (84.8%) and qat chewing (70.5%). Most patients presented with obstructive jaundice (90.2%). Definitive surgery was performed for 100 patients (44.6%), including 89 pancreatoduodenectomies using a Blumgart-style anastomosis. The clinically relevant postoperative pancreatic fistula rate was 2.2% (2/89). Palliative management was offered to 124 patients (55.4%) with advanced disease. Overall 30-day mortality was 10.3%. Mortality was significantly higher among patients aged ≥70 years (27.8% vs. 8.7%, p=0.020) and those requiring vascular resection during Whipple (33.3% vs. 15.0%, p=0.040).

Conclusion: Radical pancreatic resection with careful technique is feasible in a conflict setting and is associated with a reasonable anastomotic leak rate. However, late-stage presentations are common due to the combined effects of conflict-driven systemic stress and localised carcinogens. Stricter patient selection and improved perioperative care are essential, as demonstrated by the significant fatality rates in older patients and those undergoing vascular resection.