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. 2020 May;121(6):936-944.
doi: 10.1002/jso.25861. Epub 2020 Mar 2.

Assessment of textbook oncologic outcomes following pancreaticoduodenectomy for pancreatic adenocarcinoma

Patrick J Sweigert  1 , Emanuel Eguia  1 , Marshall S Baker  1 , Anghela Z Paredes  2 , Diamantis I Tsilimigras  2 , Mary Dillhoff  2 , Aslam Ejaz  2 , Jordan Cloyd  2 , Allan Tsung  2 , Timothy M Pawlik  2
Affiliations

Assessment of textbook oncologic outcomes following pancreaticoduodenectomy for pancreatic adenocarcinoma

Patrick J Sweigert et al. J Surg Oncol. 2020 May.

Abstract

Background: Composite outcomes may more accurately reflect patient and provider expectations around optimal care. We sought to determine the impact of achieving a so-called "textbook oncologic outcome" (TOO) among patients undergoing resection of pancreatic adenocarcinoma (PDAC).

Methods: Patients undergoing pancreaticoduodenectomy (PD) for PDAC between 2006 and 2016 were identified in the National Cancer Database (NCDB). TOO was defined by: margin negative resection, compliant lymph node evaluation, no prolonged length-of-stay, no 30-day readmission/mortality, and receipt of adjuvant chemotherapy. Factors associated with TOO and overall survival (OS) were evaluated using multivariable logistic and Cox regression models, respectively.

Results: Among 18 608 patients who underwent PD at 782 hospitals, many patients successfully achieved certain TOO factors such as R0 margin (77.9%) and no 30-day mortality (96.9%), while other TOO criteria such as receipt of adjuvant therapy (48.2%) were achieved less frequently. Overall, only 3124 (16.8%) patients achieved a TOO. Factors associated with lower odds of TOO included: older age, Black race, Medicaid insurance, Community facility, and low PD facility (<20 PD/y) (all P < .05). Achievement of a TOO was associated with lower risk of mortality (HR 0.74; 95% CI, 0.70-0.77).

Conclusions: While TOO was associated with improved long-term survival, TOO was only achieved in 16.8% of patients undergoing PD.

Keywords: adenocarcinoma; outcomes; pancreaticoduodenectomy; textbook; whipple.

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