The mean age of patients with malignant pancreatic tumors was 59.10 years (±8.87), with the 60 - 69-year age group being the most represented 42.42%). The sex ratio was 1.06. Sociodemographic characteristics revealed a predominance of single individuals (75.76%), and patients with a primary level of education (51.51%). The most frequently reported risk factors were excessive alcohol consumption (45.45%), diabetes (24.24%), and smoking (21.21%) (Table 1).

Table 1.Sociodemographic characteristics of patients with malignant pancreatic tumors at the Libreville University Hospital Center.

Abdominal pain was reported in 93.93% of patients. Overall clinical condition was impaired in all cases 100%, with anorexia observed in 93.93%, weight loss in 87.87%, asthenia in 84.84%, and jaundice in 69.7% of patients. A palpable epigastric mass was identified in 42.42% of cases (Table 2).

All patients (100%) underwent abdominal Computed Tomography (CT), while 72.73% also underwent abdominal Magnetic Resonance Imaging (MRI). Tumors were predominantly located in the head and body of the pancreas (75.76%), with a mean size of 3.8 cm (±1.5 cm). Based on CT assessment, tumors were considered resectable in only 3.03% of patients. At diagnosis, metastatic disease was present in 72.73% of cases.

Elevated carbohydrate antigen 19-9 (CA 19-9) levels were observed in 39.39% of patients. Cholestasis was present in 72.73% of cases. Histological confirmation was not obtained for all patients.

Table 2. Diagnostic and outcome characteristics of malignant pancreatic tumors at the Libreville University Hospital Center.

CT: Computed Tomography; MRI: Magnetic Resonance Imaging; PT: Prothrombin Time.

No patient underwent curative surgical resection. Endoscopic biliary drainage was performed in 6.06% of patients (n = 2). At the same time, surgical biliary bypass was carried out in 18.18% (n = 6).

Clinical outcomes were marked by a high mortality rate: 36.36% of patients died during hospitalization, 21.21% within six months after discharge, and 42.42% beyond six months following discharge.

Pancreatic diseases accounted for 8.41% of hospitalizations in our study, of which malignant tumors represented 21.43%. This result is consistent with that reported by Maganga etal. (2021), who observed that pancreatic cancers accounted for 16.1% of digestive malignancies [3]. Although relatively frequent among pancreatic diseases, malignant pancreatic tumors accounted for only 1.8% of all hospitalizations, situating our setting within a low-prevalence context, like that reported across most African countries [2]-[5][11]-[15].

This relatively low observed frequency may be partly explained by the lower prevalence of established risk factors compared with Western settings, where tobacco use, excessive alcohol consumption, and obesity constitute major public health challenges [6]-[10]. However, this apparent low burden should be interpreted with caution, as it may also reflect underdiagnosis and underreporting, particularly in low-resource settings with limited access to advanced diagnostic tools [2][3].

Male predominance, consistently reported in the literature [1][2], was also observed in our study. Among the recognized risk factors for pancreatic cancer, active smoking (21.21%), diabetes (24.24%), and chronic excessive alcohol consumption (45.45%) were the most frequently identified exposures in our cohort. The high prevalence of alcohol consumption has previously been highlighted by Mimbila et al. (2011) in adolescents and young adult populations in Libreville [16], suggesting a broader population-level exposure that may contribute to disease occurrence. These findings are consistent with previous studies demonstrating that tobacco use, diabetes, and alcohol consumption are commonly reported among patients with pancreatic cancer [17][18]. Nevertheless, given the descriptive nature of our study design, these factors should be interpreted as associated exposures rather than causal determinants.

From a diagnostic perspective, the clinical presentation was dominated by abdominal pain (93.93%), weight loss (87.87%), and jaundice (69.7%). This classical presentation is consistently reported in literature [1][2][17]-[19]. The occurrence of pain is often suggestive of unresectable disease due to celiac axis invasion and is associated with a poor prognosis [1][2][20]. These findings likely reflect the typically late clinical presentation of pancreatic cancer [1][2][11]-[14][17]-[20].

In addition, healthcare-seeking pathways influenced by socio-cultural beliefs may contribute to delayed consultation [21]. Economic constraints and limited public awareness of early clinical signs further hinder timely diagnosis [21].

From a biological standpoint, CA19-9 levels were elevated in only 39.39% of patients, corroborating findings by Siegel et al. (2022) who highlighted the limited specificity of this biomarker [2]. Abdominal Computed Tomography (CT) was the primary diagnostic modality in our study, consistent with findings reported by Kpossou et al. (2021) in Benin, whereas in Burkina Faso, Koura et al. (2020) reported that fewer than one-third of patients underwent CT imaging [13][20]. These disparities may be explained by differences in availability and cost of imaging modalities across settings [13][20].

Tumors were predominantly located in the pancreatic head, accounting for approximately three-quarters of cases, in line with reports from several African studies [5][13][15][20][22][23]. Only 3.03% of tumors were deemed resectable, confirming the advanced stage at diagnosis commonly observed in African contexts [5][13][15][20][23]. This situation likely explains why systematic histological confirmation was not performed. Indeed, similar challenges have been reported by Koura etal. in Burkina Faso, where histological confirmation was limited due to constrained technical resources and the low proportion of operable cases [13]. Likewise, Kpossou etal. reported histological confirmation in only 15.1% of cases in Benin [20].

From a therapeutic perspective, no curative surgical resection was performed, reflecting both the very low proportion of resectable tumors and limited technical capacity. Comparable findings have been reported in other African series [13][20]. Endoscopic biliary drainage was performed in 6.06% of patients, while surgical biliary bypass was carried out in 18.18%, consistent with observations by Koura etal. and Diallo et al. [13][15].

From a prognostic standpoint, in-hospital mortality reached 36.4%, comparable to the 30.8% reported by Koura et al. and consistent with global estimates reported by GLOBOCAN [3]. In contrast, higher in-hospital mortality rates (68.8%) have been reported by Kpossou et al. [4]. The poor survival observed in our cohort likely reflects delayed healthcare utilization and suboptimal treatment conditions.