Benign and Malignant Hepatic, Pancreatic, and Biliary Diseases: Surgical Spectrum, Outcomes, and Mortality Predictors in Tanzania

Background Hepatopancreatobiliary (HPB) diseases are among the most lethal surgical conditions globally, yet data from sub-Saharan Africa remain limited. While benign HPB conditions are often curable, malignant forms, particularly hepatocellular carcinoma and pancreatic cancer, carry poor prognoses, exacerbated by late presentation and limited health system capacity. Methods We conducted a one-year prospective cohort study (May 2024–May 2025) at a tertiary hospital in Tanzania, enrolling patients aged ≥13 years with surgically managed HPB diseases. Analysis was done using SPSS version 25. Results A total of 160 patients were included. Benign diseases accounted for 58.8%, predominantly gallbladder pathologies (74.9%), with a mortality rate of 4.3%. Malignant diseases comprised 41.3%, most commonly liver cancer (31.4%) and pancreatic cancer (28.4%). Overall mortality was 13.1% (n=21), of which 85.7% occurred in malignant cases. Mortality was highest in liver cancer (71.4%) and pancreatic cancer (26.3%). Independent predictors of mortality included age >60 years (AOR 2.50, 95% CI 1.10–5.80, p=0.02), operative time ≥4 hours (AOR 2.20, 95% CI 1.05–4.65, p=0.03), and digestive bypass procedures (AOR 2.20, 95% CI 1.00–4.95, p=0.05). Conclusion HPB diseases pose a substantial burden in Tanzania, with malignant conditions carrying particularly high mortality. Advanced age, prolonged operative duration, and palliative procedures independently predicted death. These findings highlight the urgent need for earlier diagnosis, structured referral systems, and expanded capacity for safe HPB resections. Strengthening multidisciplinary care and regional training in hepatobiliary and pancreatic surgery is critical to improve outcomes in resource-limited settings.