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Reprogramming Pancreatic Ductal Adenocarcinoma to Pluripotency
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Textbook Outcome/Textbook Oncological Outcome for Pancreatic Cancer Treatment.

Toru Aoyama1,2,3, Haruhiko Cho4,2, Aya Saito4

  • 1Department of Surgery, Yokohama City University, Yokohama, Japan; t-aoyama@lilac.plala.or.jp.

In Vivo (Athens, Greece)
|June 30, 2026
PubMed
Summary

Textbook outcome (TO) and textbook oncological outcome (TOO) assess pancreatic surgery quality. Achieving these outcomes improves survival for pancreatic ductal adenocarcinoma (PDAC) patients, highlighting their importance for optimizing care.

Keywords:
Resectable pancreatic canceradjuvant chemotherapydistal pancreatectomypancreaticoduodenectomyreviewtextbook oncological outcome

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Area of Science:

  • Surgical Oncology
  • Gastroenterology
  • Clinical Outcomes Research

Background:

  • Pancreatic surgery for pancreatic ductal adenocarcinoma (PDAC) has high morbidity and mortality.
  • Perioperative care quality impacts oncological outcomes in malignancies.
  • Textbook outcome (TO) and textbook oncological outcome (TOO) are emerging metrics for surgical quality.

Purpose of the Study:

  • To review the background, current status, and future perspectives of TO and TOO in pancreatic surgery.
  • To understand existing studies on TO/TOO in PDAC surgery before widespread adoption.
  • To emphasize the importance of perioperative quality in PDAC treatment.

Main Methods:

  • Literature review of studies on textbook outcome and textbook oncological outcome in pancreatic surgery.
  • Analysis of the definition and components of TO in PDAC surgery (2020).
  • Synthesis of evidence linking TO/TOO achievement with survival in PDAC patients.

Main Results:

  • TO in PDAC surgery includes six short-term outcomes: no pancreatic fistula, bile leak, hemorrhage, severe complications (Clavien-Dindo ≥III), readmission, or in-hospital mortality.
  • Previous studies indicate that achieving TO or TOO is associated with improved survival after PDAC surgery.
  • Understanding prior research is crucial for optimizing current pancreatic surgery practices.

Conclusions:

  • TO and TOO are valuable tools for evaluating and improving the quality of perioperative care in pancreatic surgery for PDAC.
  • Optimizing surgical outcomes through TO/TOO frameworks can lead to better long-term oncological results.
  • Further research and adoption of these metrics are essential for advancing PDAC treatment.