Impact of Textbook Oncologic Outcome on long term survival after resection for pancreatic adenocarcinoma.

BACKGROUND

Textbook Oncologic Outcome (TOO) has been proposed as an ideal outcome following receipt of optimal oncologic care in patients undergoing surgery for pancreatic ductal adenocarcinoma (PDAC). Our objective was to evaluate the impact of achieving TOO on long-term results after resection for PDAC.

METHODS

Data from a prospectively maintained database were retrospectively analyzed. TOO was defined as margin negative resection, compliant lymph node evaluation, LOS ≤50th percentile by year, no 30-day readmission/mortality, and adjuvant chemotherapy. Factors associated with the achievement of TOO and overall survival (OS) were evaluated.

RESULTS

From 01/2010-12/2022, 268 patients underwent pancreatic resection for PDAC including 203 (75.7 %) pancreaticoduodenectomies. The 90-day and 30-day mortality were 3.7 % and 1.9 %. Individual factors of TOO were R0 margin (76.5 %), no 30-day readmission (92.9 %), LOS ≤50th percentile (53.7 %), compliant lymphadenectomy (94.4 %) and adjuvant Chemotherapy (68.3 %). TOO was achieved only in 81 (30.2 %) patients. ASA score ≥3 was associated with a lower Odds Ratio of TOO. Median OS was 24.1 and DFS 17.3 months. Achievement of TOO had no impact on OS (24.5 months with TOO vs. 22.2 without TOO) or DFS (17.9 months with TOO vs 16.9 without TOO). The independent predictors of OS were node positivity and adjuvant chemotherapy.

CONCLUSION

TOO could be achieved in one third of pancreatic resections for PDAC but in this series was not associated with improved long-term outcomes. TOO remains a good surgical quality metric but not a prognostic marker.