Evaluation of the «textbook outcomes» surgery quality indicator as a good prognostic factor for pancreatic adenocarcinoma.

Objectives: Pancreatic surgery is burdened with high morbidity and mortality. There are quality indicators of the surgical process known as textbook outcomes (TO) that have been validated in areas such as esophagogastric surgery or liver surgery, and are beginning to be used in pancreatic surgery. This indicator assesses the absence of: 1) Mortality, 2) Pancreatic fistula, 3) Hemorrhage, 4) Biliary fistula, 5) Clavien-Dindo>II and 6) Readmission; TO is considered if all criteria are got. The aim of this study is to assess the impact of the achievement of TO on the prognosis of pancreatic adenocarcinoma.

Patients and methods: Retrospective comparative study between two periods; before and after the creation of a pancreatic surgery unit. The results have been evaluated using Textbook Outcomes and the impact on survival of the achievement of these criteria was analyzed.

Results: A total of 185 patients with pancreatic adenocarcinoma were analyzed, divided into two 5-year periods before and after the creation of the pancreatic surgery unit. There were no significant differences in clinical-pathological variables. Since the creation of the unit, TO achievement increased from 47 to 80.7% (P<.05). The OS of patients at 1, 2, and 3 years in the groups with and without TO criteria fulfillment was 86.9, 55.7, 41 and 62.7, 40.3 and 31.3% respectively, with a statistically significant difference as shown in Image 1 (P=.013). Multivariate analysis of OS showed that compliance with all TOs significantly affects mortality (HR: 0.5 [0.31-0.81]; P=.004).

Conclusion: The results support the hypothesis that the achievement of the TO surgical quality criteria has a positive impact on the oncological prognosis of curative surgery for pancreatic cancer. Centralization of pancreatic cancer surgery could help to meet the surgical quality criteria largely and thus improve the prognosis of patients.