Analysis of textbook outcomes for ampullary carcinoma patients following pancreaticoduodenectomy

Xiao-Jie Zhang; He Fei; Chun-Guang Guo; Chong-Yuan Sun; Ze-Feng Li; Zheng Li; Ying-Tai Chen; Xu Che; Dong-Bing Zhao

doi:10.4240/wjgs.v15.i10.2259

Analysis of textbook outcomes for ampullary carcinoma patients following pancreaticoduodenectomy

World J Gastrointest Surg. 2023 Oct 27;15(10):2259-2271. doi: 10.4240/wjgs.v15.i10.2259.

Authors

Xiao-Jie Zhang¹, He Fei¹, Chun-Guang Guo¹, Chong-Yuan Sun¹, Ze-Feng Li¹, Zheng Li¹, Ying-Tai Chen¹, Xu Che^{1

2}, Dong-Bing Zhao³

Affiliations

¹ Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
² Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China.
³ Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China. dbzhao@cicams.ac.cn.

Abstract

Background: Textbook outcomes (TOs) have been used to assess the quality of surgical treatment for many digestive tumours but not ampullary carcinoma (AC).

Aim: To discuss the factors associated with achieving a TO and further explore the prognostic value of a TO for AC patients undergoing curative pancreaticoduodenectomy (PD).

Methods: Patients who underwent PD at the China National Cancer Center between 1998 and 2020 were identified. A TO was defined by R0 resection, examination of ≥ 12 Lymph nodes, no prolonged hospitalization, no intensive care unit treatment, no postoperative complications, and no 30-day readmission or mortality. Cox regression analysis was used to identify the prognostic value of a TO for overall survival (OS) and recurrence-free survival (RFS). Logistic regression was used to identify predictors of a TO. The rate of a TO and of each indicator were compared in patients who underwent surgery before and after 2010.

Results: Ultimately, only 24.3% of 272 AC patients achieved a TO. A TO was independently associated with improved OS [hazard ratio (HR): 0.443, 95% confidence interval (95%CI): 0.276-0.711, P = 0.001] and RFS (HR: 0.379, 95%CI: 0.228-0.629, P < 0.001) in the Cox regression analysis. Factors independently associated with a TO included a year of surgery between 2010 and 2020 (OR: 4.549, 95%CI: 2.064-10.028, P < 0.001) and N1 stage disease (OR: 2.251, 95%CI: 1.023-4.954, P = 0.044). In addition, the TO rate was significantly higher in patients who underwent surgery after 2010 (P < 0.001) than in those who underwent surgery before 2010.

Conclusion: Only approximately a quarter (24.3%) of AC patients achieved a TO following PD. A TO was independently related to favourable oncological outcomes in AC and should be considered as an outcome measure for the quality of surgery. Further multicentre research is warranted to better elucidate its impact.

Keywords: Ampullary carcinoma; Pancreaticoduodenectomy; Prognosis; Textbook outcomes.