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

BackgroundTextbook 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 MethodsAll 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.ResultsOverall, 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)ConclusionsTO 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.