Significance of the nutritional and body composition status for predicting a postoperative Textbook Outcome after pancreaticoduodenectomy.

PURPOSES: The Textbook Outcome (TBO) is a novel quality measure in pancreatic surgery, reflecting an ideal surgical outcome. This study aimed to identify the risk factors associated with achieving a TBO after pancreaticoduodenectomy.

METHODS

We retrospectively reviewed the records of 215 patients who underwent pancreaticoduodenectomy between 2016 and 2023. A TBO was defined as the absence of all six of the following parameters: 30-day mortality, readmission, postoperative pancreatic fistula, bile leakage, post-pancreatectomy hemorrhage, and severe complications (Clavien-Dindo grade ≥ III). Logistic regression was used to evaluate the impact of various factors, including nutritional status and body composition, on TBO achievement.

RESULTS

A TBO was achieved in 123 (57.2%) patients. There were no cases of 30-day mortality reported. A multivariate analysis identified age ≥ 75 years, a soft pancreas, malnutrition as assessed by the GLIM criteria, and a high visceral fat area/skeletal muscle area ratio (VFA/SMA ratio) as significant risk factors for not achieving a TBO. Additionally, patients who achieved a TBO had a significantly better overall survival than those who did not achieve a TBO.

CONCLUSIONS

This study underscores the importance of evaluating the nutritional status and body composition to improve surgical quality. Optimizing these factors preoperatively may support the achievement of a Textbook Outcome and improve the prognosis following pancreaticoduodenectomy.