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ASSESSING TEXTBOOK ONCOLOGIC OUTCOMES IN DISTAL PANCREATECTOMY FOR PANCREATIC ADENOCARCINOMA
AHMED ALNAJAR
*, Mehmed Akcin, Jack Sleeman, Jodie A. Barkin, Daniel Sussman, Onur Kutlu
Cardiothoracic surgery, University of Miami, Miami, FL
Background: Textbook oncologic outcomes (TOO) is a composite comprehensive measure evaluating surgical success in cancer treatment, specifically in the context of distal pancreatectomy for pancreatic adenocarcinoma. This study aims to identify factors associated with achieving TOO, emphasizing the role of hospital type.
Methods: The NCDB (2010-2022) was queried for patients with clinical stage I-III pancreatic adenocarcinoma. Inclusion criteria were patients >18 underwent curative partial or total pancreatectomy. The primary outcomes was the achievement of TOO—defined as defined as R0 resection, ?12 lymph nodes examined, no prolonged hospital stay, absence of 30-day mortality, and no readmissions. Logistic regression analyses were conducted to identify predictors of TOO.
Results: Analysis of 11,194 patients showed that 38.9% achieved TOO. Achievement of TOO was associated with a median increase of one year in overall survival. Factors associated with TOO achievements in the adjusted model include female sex, private insurance, a lower Charlson/Deyo score, minimally invasive surgery (MIS), and high-volume centers. Notably, MIS emerged as a significant factor associated with 30% higher TOO (OR 1.30, CI 1.20-1.42) while treatment at high-volume hospitals was associated with 37-120% increased TOO (OR 1.37, CI 1.19-1.62 for Q3 volume and OR 2.26 CI 1.93-2.64 for Q4 volume). However, academic facility type was not significant in the adjusted model, unlike the unadjusted model.
Conclusions: Achieving TOO in distal pancreatectomy for pancreatic adenocarcinoma is significantly influenced by patient demographics, clinical characteristics, and notably, the volume of the treating facility. These findings underscore the importance of considering experience centers in surgical planning and patient counseling to optimize outcomes.
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