Textbook outcomes in pancreatic surgery: a systematic review

Pancreatectomy is associated with high morbidity and mortality, making the evaluation of surgical outcomes essential. The textbook outcome in pancreatic surgery (TOPS) combines multiple quality metrics into a single composite endpoint, providing a more representative assessment of optimal surgical care. Following PRISMA guidelines, a literature search was conducted for studies on postoperative TOPS after pancreatectomy, analyzing methodology, rates, associated factors, inter-hospital variability, and overall findings. Of 82 publications identified, 18 observational studies were included, encompassing a total of 173.995 pancreatic resections. TOPS definitions were heterogeneous, and rates ranged from 17% to 70%. TOPS was associated with patient, hospital, and surgery-related factors. This systematic review summarizes the contemporary international experience with TOPS as a patient-centered composite metric, suitable for quantifying "ideal" care and comparing outcomes among centers performing pancreatic surgery.