Development of a Modified Textbook Outcome in Evaluating Robot-Assisted Middle Pancreatectomy: A Real-World Study of RMP Surgery in a High-Volume Pancreatic Disease Center.

OBJECTIVE

We aimed to, for the first time, assess the value of modified textbook outcome (mTO) in robot-assisted middle pancreatectomy (RMP) procedures.

SUMMARY BACKGROUND DATA: Pancreatic fistula remains to be the major complication after RMP. Textbook outcome (TO) is introduced to capture the most desirable surgical outcomes. The value of TO in RMP surgery remains unknown.

METHODS

All patients who underwent RMP in our center from 2010 to 2023 were enrolled in the study. Baseline characteristics, operative outcomes, and oncological outcomes were collected and analyzed. Textbook outcome was calculated separately for each patient and analyzed.

RESULTS

The mTO was defined by the absence of modified post-operative pancreatic fistula (mPOPF), postpancreatectomy hemorrhage (PPH), severe complications (Clavien-Dindo ≥ III), readmission, and in-hospital mortality (IHM). The overall mTO rate and mPOPF rate of 209 patients were 73.68% and 15.79%, respectively. Patients who achieved modified textbook outcomes have shorter post-operative hospitalization days (median (IQR), 17 (9) vs. 34 (26), p < 0.001). Passing the learning curve leads to a reduction of the mPOPF rate and an increase of the mTO rate.

CONCLUSIONS

Modified textbook outcome is a practical metric for evaluating ideal surgical outcomes in RMP surgery. Follow-up multi-center clinical research is necessary to evaluate this indicator even further.