Charlotte M Heidsma1, Madison Hyer1, Diamantis I Tsilimigras1, Flavio Rocha2, Daniel E Abbott3, Ryan Fields4, Paula M Smith5, George A Poultsides6, Clifford Cho7, Shishir K Maithel8, Timothy M Pawlik1. 1. Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio. 2. Department of Surgery, Virginia Mason Medical Center, Seattle, Washington. 3. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. 4. Department of Surgery, Washington University School of Medicine, St. Louis, Wisconsin. 5. Department of Surgery, Division of Surgical Oncology, Vanderbilt University, Nashville, Tennessee. 6. Department of Surgery, Stanford University, Stanford, California. 7. Department of Surgery, Division of Hepatopancreatobiliary and Advanced Gastrointestinal Surgery, University of Michigan, Ann Arbor, Michigan. 8. Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia.
Abstract
BACKGROUND AND OBJECTIVES: We sought to define the incidence and impact of Textbook Outcome (TO) on disease-free survival [DFS] among patients undergoing resection of pancreatic neuroendocrine tumors (PNET). METHODS: Patients undergoing resection of a PNET between 2000 and 2016 were identified using a multi-institutional database. TO was defined as no postoperative severe complications (Clavien-Dindo grade ≥ III), no 90-day mortality, no prolonged length-of-hospital stay (LOS) (ie, > 75th percentile), no 90-day readmission after discharge, and R0 resection. The 5-year DFS was calculated and the association with TO was examined. RESULTS: Among 821 patients with a PNET, median tumor size was 2.1 cm (IQR 1.4-14.6). Resection consisted of pancreatoduodenectomy (PD) (n = 231, 28.1%), distal pancreatectomy (DP) (n = 492, 59.9%), and enucleation (EN) (n = 98, 11.9%). Overall TO rate was 49.3% (n = 405). The incidence of TO varied by procedure type (PD: 32.5% vs DP: 56.7% vs EN: 52.0%; P < .001). After adjusting for all competing factors, achievement of a TO was independently associated with improved DFS (hazard ratio: 0.54, 95% CI, 0.35-0.81; P = .003). CONCLUSIONS: Only one in two patients undergoing resection of a PNET achieved a TO, which varied markedly based on procedure type. Achievement of a TO was associated with improved DFS.
BACKGROUND AND OBJECTIVES: We sought to define the incidence and impact of Textbook Outcome (TO) on disease-free survival [DFS] among patients undergoing resection of pancreatic neuroendocrine tumors (PNET). METHODS:Patients undergoing resection of a PNET between 2000 and 2016 were identified using a multi-institutional database. TO was defined as no postoperative severe complications (Clavien-Dindo grade ≥ III), no 90-day mortality, no prolonged length-of-hospital stay (LOS) (ie, > 75th percentile), no 90-day readmission after discharge, and R0 resection. The 5-year DFS was calculated and the association with TO was examined. RESULTS: Among 821 patients with a PNET, median tumor size was 2.1 cm (IQR 1.4-14.6). Resection consisted of pancreatoduodenectomy (PD) (n = 231, 28.1%), distal pancreatectomy (DP) (n = 492, 59.9%), and enucleation (EN) (n = 98, 11.9%). Overall TO rate was 49.3% (n = 405). The incidence of TO varied by procedure type (PD: 32.5% vs DP: 56.7% vs EN: 52.0%; P < .001). After adjusting for all competing factors, achievement of a TO was independently associated with improved DFS (hazard ratio: 0.54, 95% CI, 0.35-0.81; P = .003). CONCLUSIONS: Only one in two patients undergoing resection of a PNET achieved a TO, which varied markedly based on procedure type. Achievement of a TO was associated with improved DFS.
Authors: Alessandro Paro; Djhenne Dalmacy; J Madison Hyer; Diamantis I Tsilimigras; Adrian Diaz; Timothy M Pawlik Journal: Ann Surg Oncol Date: 2021-04-24 Impact factor: 5.344
Authors: Megan A Cibulas; Azalia Avila; Ashwin M Mahendra; Shenae K Samuels; Christopher J Gannon; Omar H Llaguna Journal: Ann Surg Oncol Date: 2022-08-16 Impact factor: 4.339