The Value of Textbook Outcome in Benchmarking Pancreatoduodenectomy for Nonfunctioning Pancreatic Neuroendocrine Tumors

Ann Surg Oncol. 2024 Jun;31(6):4096-4104. doi: 10.1245/s10434-024-15114-1. Epub 2024 Mar 10.

Abstract

Background: Textbook outcome (TO) is a composite variable that can define the quality of pancreatic surgery. The aim of this study is to evaluate TO after pancreatoduodenectomy (PD) for nonfunctioning pancreatic neuroendocrine tumors (NF-PanNETs).

Patients and methods: All patients who underwent PD for NF-PanNETs (2007-2016) in different centers were included in this retrospective study. TO was defined as the absence of severe postoperative complications and mortality, length of hospital stay ≤ 19 days, R0 resection, and at least 12 lymph nodes harvested.

Results: Overall, 477 patients were included. The TO rate was 32%. Tumor size [odds ratio (OR) 1.696; p = 0.013], a minimally invasive approach (OR 12.896; p = 0.001), and surgical volume (OR 2.062; p = 0.023) were independent predictors of TO. The annual frequency of PDs increased over time as well as the overall rate of TO. At a median follow-up of 44 months, patients who achieved TO had similar disease-free (p = 0.487) and overall survival (p = 0.433) rates compared with patients who did not achieve TO. TO rate in patients with NF-PanNET > 2 cm was 35% versus 27% in patients with NF-PanNET ≤ 2 cm (p = 0.044). Considering only NF-PanNETs > 2 cm, patients with TO and those without TO had comparable 5-year overall survival rates (p = 0.766) CONCLUSIONS: TO is achieved in one-third of patients after PD for NF-PanNETs and is not associated with a benefit in terms of long-term survival.

Keywords: Long-term survival; Nonfunctioning pancreatic neuroendocrine tumors; Pancreaticoduodenectomy; Postoperative complications; Surgical volume; Textbook outcome.

MeSH terms

  • Adult
  • Aged
  • Benchmarking*
  • Female
  • Follow-Up Studies
  • Humans
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Neuroendocrine Tumors / pathology
  • Neuroendocrine Tumors / surgery
  • Pancreatic Neoplasms* / mortality
  • Pancreatic Neoplasms* / pathology
  • Pancreatic Neoplasms* / surgery
  • Pancreaticoduodenectomy*
  • Postoperative Complications*
  • Prognosis
  • Retrospective Studies
  • Survival Rate

Supplementary concepts

  • Non functioning pancreatic endocrine tumor