Zhang XJ, Fei H, Guo CG, Sun CY, Li ZF, Li Z, Chen YT, Che X, Zhao DB. Analysis of textbook outcomes for ampullary carcinoma patients following pancreaticoduodenectomy. World J Gastrointest Surg 2023; 15(10): 2259-2271 [PMID: 37969713 DOI: 10.4240/wjgs.v15.i10.2259]
Corresponding Author of This Article
Dong-Bing Zhao, MD, Doctor, Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China. dbzhao@cicams.ac.cn
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Oct 27, 2023; 15(10): 2259-2271 Published online Oct 27, 2023. doi: 10.4240/wjgs.v15.i10.2259
Analysis of textbook outcomes for ampullary carcinoma patients following pancreaticoduodenectomy
Xiao-Jie Zhang, He Fei, Chun-Guang Guo, Chong-Yuan Sun, Ze-Feng Li, Zheng Li, Ying-Tai Chen, Xu Che, Dong-Bing Zhao
Xiao-Jie Zhang, He Fei, Chun-Guang Guo, Chong-Yuan Sun, Ze-Feng Li, Zheng Li, Ying-Tai Chen, Xu Che, Dong-Bing Zhao, Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Xu Che, Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China
Author contributions: Zhang XJ, Fei H and Guo CG contributed equally to this work; Chen YT, Che X and Zhao DB designed the research study, they are the corresponding authors of this paper; Fei H and Zhang XJ analyzed the data; Sun CY, Li Z and Li ZF collected the data; All author wrote the manuscript; All authors have read and approve the final manuscript.
Institutional review board statement: Ethical review and approval were not required for this study in accordance with the National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: None of the authors have conflicts of interest related to the manuscript.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dong-Bing Zhao, MD, Doctor, Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China. dbzhao@cicams.ac.cn
Received: July 11, 2023 Peer-review started: July 11, 2023 First decision: August 31, 2023 Revised: September 1, 2023 Accepted: September 7, 2023 Article in press: September 7, 2023 Published online: October 27, 2023 Processing time: 108 Days and 6.6 Hours
Abstract
BACKGROUND
Textbook outcomes (TOs) have been used to assess the quality of surgical treatment for many digestive tumours but not ampullary carcinoma (AC).
AIM
To discuss the factors associated with achieving a TO and further explore the prognostic value of a TO for AC patients undergoing curative pancreaticoduodenectomy (PD).
METHODS
Patients who underwent PD at the China National Cancer Center between 1998 and 2020 were identified. A TO was defined by R0 resection, examination of ≥ 12 Lymph nodes, no prolonged hospitalization, no intensive care unit treatment, no postoperative complications, and no 30-day readmission or mortality. Cox regression analysis was used to identify the prognostic value of a TO for overall survival (OS) and recurrence-free survival (RFS). Logistic regression was used to identify predictors of a TO. The rate of a TO and of each indicator were compared in patients who underwent surgery before and after 2010.
RESULTS
Ultimately, only 24.3% of 272 AC patients achieved a TO. A TO was independently associated with improved OS [hazard ratio (HR): 0.443, 95% confidence interval (95%CI): 0.276-0.711, P = 0.001] and RFS (HR: 0.379, 95%CI: 0.228-0.629, P < 0.001) in the Cox regression analysis. Factors independently associated with a TO included a year of surgery between 2010 and 2020 (OR: 4.549, 95%CI: 2.064-10.028, P < 0.001) and N1 stage disease (OR: 2.251, 95%CI: 1.023-4.954, P = 0.044). In addition, the TO rate was significantly higher in patients who underwent surgery after 2010 (P < 0.001) than in those who underwent surgery before 2010.
CONCLUSION
Only approximately a quarter (24.3%) of AC patients achieved a TO following PD. A TO was independently related to favourable oncological outcomes in AC and should be considered as an outcome measure for the quality of surgery. Further multicentre research is warranted to better elucidate its impact.
Core Tip: Surgery has improved substantially with advances in surgical techniques, however we still lack an effective measure to evaluate the quality of surgery in ampullary carcinoma. As a composite metric, textbook outcome (TO) concluded the strengths of all indicators based on important short-term outcomes, which was more reliable and comprehensive than single outcome measure. Pancreaticoduodenectomy was still quite complicated and required a broad judgement to monitor and compare the quality of procedures. TO should be considered as an outcome measurement for the quality of surgery, our study will be helpful in completely and effectively evaluating the overall quality of surgical care, and even in the hospital administration.
