SP 7.04 Retrospective Audit of Cardiovascular Risk in Patients Undergoing Pancreaticoduodenectomy

Abstract Introduction Pancreatic cancer is a highly metabolic disease with high-risk of major adverse cardio-vascular events (MACE). Those undergoing surgery who take statins have longer survival. QRISK3 scoring estimates the risk of acute myocardial infarction or stroke within 10 years in the UK population, and NICE recommends its validated use to guide optimal metabolic therapy (OMT). In patients undergoing pancreaticoduodenectomy the relationship between QRISK3 score and OMT, MACE, or survival is unknown. Methods QRISK3 was retrospectively calculated in patients undergoing pancreaticoduodenectomy for invasive malignancy (2022-2024). Rates of OMT and MACE (+/- all cause mortality [ACM]) were determined. The relationship between QRISK3 and survival was explored using Cox regression. Results Data from 114 patients were reviewed; male 50 (44%), median (IQR) age 67 (59-73) years. At 1-year: in high-risk (QRISK3≥20%) patients OMT 4/46 (8.7%), MACE+ACM 7/46 (15.2%); moderate-risk (QRISK3≥10%) OMT 6/38 (15.8%), MACE+ACM 3/38 (7.9%); low-risk (QRISK3<10%) OMT 29/30 (96.7%), MACE+ACM 2/30 (6.7%). QRISK3 score independently predicted survival (median 24 months) in all cancer types (HR [95%CI] 1.033 [1.002-1.065] p=0.037). In pancreatic ductal adenocarcinoma (n=46), QRISK3 score remained a predictor of survival (HR [95%CI] 1.056 [1.001-1.140] p=0.047) after accounting for T stage, N stage, R0 resection and chemotherapy status. Conclusion Patients undergoing pancreatic surgery are at high-risk of MACE and mortality and receive sub-optimal prevention. Pre-operative cardiovascular risk assessment and mitigation with OMT could improve outcomes. QRISK3 score may predict overall survival but further work is required to validate and fully understand this relationship.