Textbook outcome following surgery for pancreatic neuroendocrine tumours: retrospective study

Recent improvements in pancreatic surgery outcomes have highlighted the relevance of comprehensive quality measures, including textbook outcome. The aim of this study was to evaluate textbook outcome in patients with pancreatic neuroendocrine tumours undergoing surgical resection.

All patients undergoing surgery for pancreatic neuroendocrine tumours between 2010 and 2023 were included. Textbook outcome was defined as the absence of severe morbidity (Clavien-Dindo grade ≥ III), pancreatic fistula, bile leakage, haemorrhage, readmission, and no death. Logistic regression analysis was used to identify risk factors and Kaplan-Meier survival analysis to compare disease-free and overall survival.

A total of 622 patients underwent surgery for pancreatic neuroendocrine tumours. Major morbidity occurred in 192 patients (30.9%) with an in-hospital mortality rate of 2.6% (16 patients). Rates of postoperative pancreatic fistula, haemorrhage, and readmission were 21.5, 6.4, and 10.3% respectively. Overall, a textbook outcome was achieved in 399 patients (64.1%), with a higher rate after organ-sparing versus formal resections (89 (74.8%) versus 310 (61.6%); P = 0.008). Risk factors for non-textbook outcome were older age (odds ratio 1.52, 95% confidence interval 1.05 to 2.20; P = 0.028), higher body mass index (odds ratio 1.61, 95% CI 1.15 to 2.25; P = 0.006), American Society of Anesthesiologists grade ≥ III (odds ratio 1.63, 95% CI 1.14 to 2.35; P = 0.008), and longer duration of surgery (odds ratio 1.69, 95% CI 1.17 to 2.45; P = 0.006). Patients with a textbook outcome had higher 5-year rates of disease-free (73 versus 67%; P = 0.025) and overall (88 versus 78%; P < 0.001) survival than those with a non-textbook outcome. This effect was confirmed in patients with non-functioning pancreatic neuroendocrine tumours (overall survival: 85 versus 77%; P = 0.003). In multivariable analysis, textbook outcome remained an independent predictor of survival.

A textbook outcome was achieved in most patients undergoing pancreatic surgery for pancreatic neuroendocrine tumours and was associated with improved long-term survival. Textbook outcome may serve as a quality control and prognostic indicator in surgery for pancreatic neuroendocrine tumours.