Analysis of textbook outcomes for ampullary carcinoma patients following pancreaticoduodenectomy

Table 1 Baseline characteristics for patients with or without a Textbook Outcome after pancreatoduodenectomy

Characteristic	Textbook outcome		No textbook outcome		P value
	n = 66	Percentage	n = 206	Percentage
Year of surgery					< 0.001
1998-2010	15	22.7%	117	56.8%
2011-2020	51	77.3%	89	43.2%
Sex					0.634
Male	40	60.6%	118	57.3%
Female	26	39.4%	88	42.7%
Age (yr)					0.618
≤ 60	42	63.6%	124	60.2%
> 60	24	36.4%	82	39.8%
Operation time (h)					0.622
≤ 6	45	68.2%	147	71.4%
> 6	21	31.8%	59	28.3%
Blood transfusion					0.328
No	35	53.0%	95	46.1%
Yes	31	47.0%	111	53.9%
Tumor size (cm)					0.155
≤ 2.0	27	40.9%	105	51.0%
> 2.0	39	59.1%	101	49.0%
Differentiation					0.369
Well	10	15.2%	47	22.8%
Moderate	29	43.9%	88	42.7%
Poor	27	40.9%	71	34.5%
CA199					0.941
0-40	23	34.8%	74	35.9%
> 40	37	56.1%	111	53.9%
unknown	6	9.1%	21	10.2%
N stage					0.038
N0	39	59.1%	154	74.8%
N1	23	34.8%	41	19.9%
N2	4	6.1%	11	5.3%
T stage					0.585
T1	9	13.6%	33	16.0%
T2	26	39.4%	67	32.5%
T3	31	47.0%	106	51.5%
TNM stage					0.034
I	29	43.9%	93	45.1%
II	10	15.2%	58	28.2%
III	27	40.9%	55	26.7%
Lymphovascular invasion					0.001
No	40	60.6%	166	80.6%
Yes	26	39.4%	40	19.4%
Adjuvant treatment					0.223
No	15	22.7%	31	15.0%
Yes	16	24.2%	43	20.9%
Unknown	35	53%	132	64.1%

Table 2 Univariable and multivariable Cox regression analyses of clinicopathological factors for overall survival

Characteristic	Univariable analysis		Multivariable analysis
	HR (95%CI)	P value	HR (95%CI)	P value
Textbook outcome
No	Reference		Reference
Yes	0.598 (0.383-0.934)	0.024	0.443 (0.276-0.711)	0.001
Year of surgery
1998-2010	Reference
2011-2020	1.095 (0.767-1.562)	0.619
Sex
Male	Reference
Female	0.914 (0.641-1.303)	0.619
Age (yr)
≤ 60	Reference
> 60	1.254 (0.875-1.797)	0.218
Operation time (h)
≤ 6	Reference
> 6	1.259 (0.861-1.839)	0.235
Blood transfusion
No	Reference
yes	0.998 (0.702-1.417)	0.990
Tumor size (cm)
≤ 2.0	Reference		Reference
> 2.0	1.396 (0.985-1.978)	0.061	1.327 (0.919-1.917)	0.131
Differentiation
Poor	Reference		Reference
Moderate	1.077 (0.730-1.588)	0.709	1.243 (0.830-1.863)	0.291
Well	0.644 (0.389-1.065)	0.086	1.026 (0.563-1.868)	0.934
CA199
0-40	Reference		Reference
> 40	1.495 (1.010-2.213)	0.045	1.339 (0.885-2.026)	0.168
Unknown	1.393 (0.741-2.619)	0.303	2.022 (1.025-3.990)	0.042
N stage
N0	Reference		Reference
N1	1.939 (1.303-2.886)	0.001	1.872 (1.178-2.977)	0.008
N2	2.077 (1.002-4.305)	0.049	1.850 (0.856-4.002)	0.118
T stage
T1	Reference		Reference
T2	1.092 (0.616-1.936)	0.764	0.824 (0.441-1.542)	0.546
T3	2.230 (1.309-3.799)	0.003	1.469 (0.771-2.799)	0.243
Lymphovascular invasion
No	Reference		Reference
Yes	1.528 (1.026-2.275)	0.037	1.252 (0.797-1.966)	0.330
Adjuvant treatment
No	Reference
Yes	1.082 (0.624-1.876)	0.780
Unknown	0.886 (0.548-1.431)	0.620

95%CI: 95% Confidence interval; HR: Hazard ratio.

Table 3 Univariable and multivariable Cox regression analyses of clinicopathological factors for recurrence free survival

Characteristic	Univariable analysis		Multivariable analysis
	HR (95%CI)	P value	HR (95%CI)	P value
Textbook outcome
No	Reference		Reference
Yes	0.607 (0.382-0.963)	0.034	0.379 (0.228-0.629)	< 0.001
Year of surgery
1998-2010	Reference
2011-2020	1.030 (0.703-1.509)	0.879
Sex
Male	Reference
Female	1.009 (0.685-1.485)	0.965
Age (yr)
≤ 60	Reference
> 60	0.972 (0.652-1.449)	0.891
Operation time (h)
≤ 6	Reference
> 6	1.051 (0.689-1.603)	0.818
Blood transfusion
No	Reference
Yes	0.932 (0.638-1.363)	0.717
Tumor size (cm)
≤ 2.0	Reference		Reference
> 2.0	1.540 (1.051-2.257)	0.027	1.365 (0.909-2.048)	0.133
Differentiation
Poor	Reference		Reference
Moderate	1.112 (0.730-1.693)	0.622	1.472 (0.946-2.290)	0.086
Well	0.546 (0.307-0.974)	0.040	1.002 (0.508-1.976)	0.997
CA199
0-40	Reference
> 40	1.751 (1.145-2.677)	0.010	1.601 (1.025-2.501)	0.038
Unknown	1.225 (0.584-2.568)	0.591	1.646 (0.746-3.634)	0.217
N stage
N0	Reference		Reference
N1	1.801 (1.170-2.771)	0.008	1.675 (1.006-2.789)	0.047
N2	2.563 (1.173-5.604)	0.018	1.807 (0.833-4.138)	0.162
T stage
T1	Reference		Reference
T2	1.152 (0.613-2.166)	0.661	0.885 (0.446-1.754)	0.726
T3	2.488 (1.387-4.463)	0.002	1.419 (0.709-2.842)	0.323
Lymphovascular invasion
No	Reference		Reference
Yes	2.002 (1.321-3.033)	0.001	1.892 (1.161-3.081)	0.010
Adjuvant treatment
No	Reference
Yes	1.271 (0.730-2.215)	0.397
Unknown	0.671 (0.405-1.112)	0.122

95%CI: 95% Confidence interval; HR: Hazard ratio.

Table 4 Univariable and multivariable logistic regression analyses of factors associated with textbook outcome

Characteristic	Univariable analysis		Multivariable analysis
	OR (95%CI)	P value	OR (95%CI)	P value
Year of surgery
1998-2010	Reference		Reference
2011-2020	4.470 (2.361-8.462)	< 0.001	4.549 (2.064-10.028)	< 0.001
Sex
Male	Reference
Female	0.872 (0.495-1.535)	0.634
Age (yr)
≤ 60	Reference
> 60	0.864 (0.487-1.534)	0.618
Operation time (h)
≤ 6	Reference
> 6	1.163 (0.638-2.118)	0.622
Transfusion
No	Reference
Yes	0.758 (0.435-1.321)	0.328
Tumor size (cm)
≤ 2.0	Reference		Reference
> 2.0	1.502 (0.856-2.633)	0.156	1.728 (0.924-3.231)	0.087
Differentiation
Poor	Reference		Reference
Moderate	0.867 (0.471-1.595)	0.646	1.194 (0.597-2.390)	0.616
Well	0.559 (0.248-1.262)	0.162	1.007 (0.360-2.812)	0.990
CA199
0-40	Reference
> 40	1.072 (0.590-1.950)	0.819
Unknown	0.919 (0.331-2.551)	0.872
N stage
N0	Reference		Reference
N1	2.215 (1.192-4.117)	0.012	2.251 (1.023-4.954)	0.044
N2	1.436 (0.434-4.754)	0.554	1.236 (0.314-4.864)	0.762
T stage
T1	Reference		Reference
T2	1.423 (0.599-3.380)	0.424	1.205 (0.455-3.191)	0.707
T3	1.072 (0.464-2.481)	0.870	0.449 (0.150-1.341)	0.151
Lymphovascular invasion
No	Reference		Reference
Yes	2.697 (1.477-4.927)	0.001	1.483 (0.688-3.199)	0.315
Adjuvant treatment
No	Reference		Reference
Yes	0.769 (0.331-1.785)	0.541	1.144 (0.450-2.912)	0.777
Unknown	0.548 (0.267-1.126)	0.102	1.459 (0.629-3.387)	0.379

95%CI: 95% Confidence interval; OR: Odds ratio.

Table 5 Trends over years for individual textbook outcome parameters after controlling clinicopathological factors by logistic regression analyses

Characteristic	OR (95%CI)	P value
R0 resection	-	-
≥ 12 lymph nodes examined	14.620 (5.323-40.156)	< 0.001
No ICU treatment	0.255 (0.052-1.258)	0.093
No postoperative complications	3.375 (1.268-8.984)	0.015
No prolonged hospitalization	2.057 (0.738-5.734)	0.168
No 30-d readmission or mortality	6.399 (0.496-82.620)	0.155

95%CI: 95% Confidence interval; ICU: Intensive care unit; OR: Odds ratio.