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. 2024 Feb 6;22(1):43.
doi: 10.1186/s12957-024-03322-8.

Textbook oncologic outcomes are associated with increased overall survival in patients with pancreatic head cancer after undergoing laparoscopic pancreaticoduodenectomy

Jing Zhang  1 , He Cai  1 , Man Zhang  2 , Xin Wang  1 , Yunqiang Cai  1   3 , Bing Peng  4
Affiliations

Textbook oncologic outcomes are associated with increased overall survival in patients with pancreatic head cancer after undergoing laparoscopic pancreaticoduodenectomy

Jing Zhang et al. World J Surg Oncol. .

Abstract

Background: Textbook oncologic outcomes (TOO) have been used to evaluate long-term oncologic outcomes for patients after pancreaticoduodenectomy (PD) but not laparoscopic pancreaticoduodenectomy (LPD). The aim of the study was to assess the prognostic value of TOO for patients with pancreatic head cancer undergoing LPD and discuss the risk factors associated with achieving TOO.

Methods: Patients with pancreatic head cancer who underwent LPD in West China Hospital from January 2015 to May 2022 were consecutively enrolled. TOO was defined as achieving R0 resection, examination of ≥ 12 lymph nodes, no prolonged length of stay, no 30-day readmission/death, and receiving adjuvant chemotherapy. Survival analysis was used to determine the prognostic value of a TOO on overall survival (OS) and recurrence-free survival (RFS). Logistic regression was used to identify the risk factors of a TOO. The rates of a TOO and of each indicator were compared in patients who suffered or not from delayed gastric emptying (DGE).

Results: A total of 44 (25.73%) patients achieved TOO which was associated with improved median OS (TOO 32 months vs. non-TOO 20 months, P = 0.034) and a better RFS (TOO 19 months vs. non-TOO 13 months, P = 0.053). Patients suffering from DGE [odds ratio (OR) 4.045, 95% CI 1.151-14.214, P = 0.029] were independent risk factors for TOO. In addition, patients with DGE after surgery had a significantly lower rate of TOO (P = 0.015) than patients without DGE.

Conclusions: As there were significant differences between patients who achieved TOO or not, TOO is a good indicator for long-term oncologic outcomes in patients with pancreatic head cancer after undergoing LPD. DGE is the risk factor for achieving TOO, so it is important to prevent the DGE after LPD to improve the rate of TOO.

Keywords: Laparoscopic pancreaticoduodenectomy; Pancreatic head cancer; Prognosis; Textbook oncologic outcome.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Textbook oncologic outcome (parameter and cumulative) after laparoscopic pancreaticoduodenectomy. LAD, lymphadenectomy; LOS, postoperative length of stay; TOO, textbook oncologic outcome
Fig. 2
Fig. 2
Kaplan‐Meier survival functions by receipt of the textbook oncologic outcome. a Survival curves for survival study population by receipt of the textbook oncologic outcome. b The disease-free survival curves study population by receipt of the textbook oncologic outcome. mOS, median overall survival; mRFS, median recurrence-free survival
Fig. 3
Fig. 3
Textbook oncologic outcome (parameter and cumulative) after laparoscopic pancreaticoduodenectomy by group using DGE. LAD, lymphadenectomy; LOS, postoperative length of stay; TOO, textbook oncologic outcome; DGE, delayed gastric emptying
See this image and copyright information in PMC

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