Analysis of textbook outcomes for ampullary carcinoma patients following pancreaticoduodenectomy  

作　　者：Xiao-Jie Zhang He Fei Chun-Guang Guo Chong-Yuan Sun Ze-Feng Li Zheng Li Ying-Tai Chen Xu Che Dong-Bing Zhao 

机构地区：[1]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 [2]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

出　　处：《World Journal of Gastrointestinal Surgery》2023年第10期2259-2271,共13页世界胃肠外科杂志（英文版）（电子版）

摘　　要：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.

关 键 词：Ampullary carcinoma Textbook outcomes PANCREATICODUODENECTOMY PROGNOSIS 

分 类 号：R735.0[医药卫生—肿瘤]