Defining and predicting textbook outcomes in laparoscopic distal pancreatectomy

Area of Science:

• Surgical Oncology
• Minimally Invasive Surgery
• Gastroenterology

Background:

• Laparoscopic distal pancreatectomy (LDP) is standard for pancreatic body/tail lesions.
• A standardized metric for LDP surgical quality is lacking.
• Textbook outcome (TO) is validated for other pancreatic surgeries but not LDP.

Purpose of the Study:

• Establish procedure-specific criteria for TO in LDP.
• Identify independent predictors of TO failure in LDP patients.

Main Methods:

• Retrospective analysis of 405 LDP patients (Jan 2015-Aug 2022).
• TO defined by absence of specific complications, readmission, and mortality.
• Multivariable logistic regression and nomogram construction for predictor identification.

Main Results:

• 70.6% of patients achieved TO.
• Female sex was protective against TO failure.
• Preoperative EUS-FNA, pancreatic portal hypertension, and lesion type (cystic-solid/solid) predicted TO failure.

Conclusions:

• The LDP-specific TO definition is feasible and discriminative.
• The developed nomogram offers objective risk assessment for LDP patients.