Textbook outcome following surgery for pancreatic neuroendocrine neoplasms

Objective: Recent improvements in pancreatic surgery outcomes have highlighted the relevance of comprehensive quality measures, including textbook outcome (TO). This study aimed to evaluate TO in patients with pancreatic neuroendocrine neoplasms (pNEN) undergoing surgical resection.

Methods: All patients undergoing surgery for pNEN at our center between 2010 and 2023 were included. TO was defined as the absence of severe morbidity (Clavien-Dindo grade≥3), the absence of pancreas-specific complications, no re-admission and no mortality. Logistic regression analysis was used to identify risk factors associated with non-TO and Kaplan-Meier survival analysis was performed to compare disease-free and overall survival rates between TO and non-TO groups.

Results: A total of 622 patients underwent surgery for pNEN. Of these 86.3% had non-functioning tumors and the majority (81%) underwent formal resection. Major morbidity occurred in 31.7% of patients with an in-hospital mortality of 2.6%. Rates of postoperative pancreatic fistula, post-pancreatectomy hemorrhage and re-admission were 21.5%, 6.4% and 10.3%, respectively. Overall TO was achieved in 63.8% of cases which was higher in organ-sparing resections compared to formal resections (74.8% vs 61.2%, p=0.007). Risk factors for not achieving TO were higher age (OR: 1.63; 95% CI, 1.18-2.27, p=0.003), higher BMI (OR: 1.6; 95% CI, 1.14-2.28, p=0.006), ASA Score≥3 (OR 1.6, 95% CI 1.12-2.3, p=0.011) and longer duration of surgery (OR: 1.84; 95% CI, 1.32-2.57, p<0.001). Patients who achieved TO had significantly higher 5-year disease-free (73% vs 66%, p=0.022) and overall survival rates (87% vs 78%, p<0.001) compared to those without TO. This effect was confirmed in subgroup analyses of non-functioning pNEN (OS: 85% vs 77%, p=0.003) as well as in formal resections (OS: 82% vs 75%, p=0.014). On multivariable analysis, TO was confirmed as an independent predictor of post-resection survival.

Conclusions: TO is achieved in the majority of patients undergoing pancreatic surgery for pNEN and is associated with significantly improved long-term survival. Therefore, TO may serve as quality control and prognostic indicator in patients with pNEN.

Publikationsverlauf

Artikel online veröffentlicht:
04. September 2025