Zhi-Wei Zhang, MD, Doctor, Division of Hepato-Pancreato-Biliary Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan 430000, Hubei Province, China. zhiweizhang@tjh.tjmu.edu.cn
Research Domain of This Article
Gastroenterology & Hepatology
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/
Xiao-Rui Huang, Deng-Sheng Zhu, Xin-Yi Guo, Jing-Zhao Zhang, Zhen Zhang, Huan Zheng, Tong Guo, Ya-Hong Yu, Zhi-Wei Zhang, Division of Hepato-Pancreato-Biliary Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430000, Hubei Province, China
Co-first authors: Xiao-Rui Huang and Deng-Sheng Zhu.
Co-corresponding authors: Ya-Hong Yu and Zhi-Wei Zhang.
Author contributions: Huang XR and Zhu DS contributed equally to this work as co-first authors; Huang XR was responsible for study design, data curation, conceptualization, methodology, and drafting the initial manuscript; Zhu DS performed formal data analysis and co-drafted the manuscript; Guo XY and Zhang JZ completed case data collection, follow-up, and data organization; Zhang Z and Zheng H participated in the literature search for the manuscript and the production of related figures and tables; Guo T provided manuscript revision suggestions; Yu YH and Zhang ZW, as co-corresponding authors, contributed equally to study supervision, funding acquisition, and critical review/editing of the manuscript; all authors approved the final version of the manuscript.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (No. TJ-IRB202407020).
Informed consent statement: Informed consent statement was waived owing to the study’s retrospective design.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.
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: Zhi-Wei Zhang, MD, Doctor, Division of Hepato-Pancreato-Biliary Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan 430000, Hubei Province, China. zhiweizhang@tjh.tjmu.edu.cn
Received: October 13, 2025 Revised: November 9, 2025 Accepted: November 19, 2025 Published online: January 7, 2026 Processing time: 89 Days and 15.2 Hours
Abstract
BACKGROUND
Laparoscopic distal pancreatectomy (LDP) has emerged as the preferred approach for both benign and malignant lesions located in the pancreatic body and tail. Nevertheless, a notable deficiency persists in the absence of a standardized, procedure-specific metric for evaluating and comparing surgical quality. A composite measure termed “textbook outcome (TO)”, which encompasses key short-term endpoints, has been validated in laparoscopic pancreatoduodenectomy but has not yet been established in dedicated LDP cohorts. The definition and prediction of TO in this context could aid in facilitating cross-institutional benchmarking and fostering advancements in quality improvement.
AIM
To establish procedure-specific criteria for TO and identify independent predictors of TO failure in patients undergoing LDP.
METHODS
Consecutive patients who underwent LDP at a single high-volume pancreatic center between January 2015 and August 2022 were retrospectively analyzed. TO was defined as the absence of clinically relevant postoperative pancreatic fistula (grade B/C), post-pancreatectomy hemorrhage (grade B/C), severe complications (Clavien-Dindo ≥ III), readmission within 30 days, and in-hospital or 30-day mortality. Multivariable logistic regression was employed to identify independent predictors of TO failure, and a nomogram was constructed and internally validated.
RESULTS
Among 405 eligible patients, 286 (70.6%) attained TO. Multivariable analysis revealed that female sex [odds ratio (OR) = 0.62, 95% confidence interval (CI): 0.39-0.99] conferred a protective effect, while preoperative endoscopic ultrasound-guided fine-needle aspiration (OR = 2.66, 95%CI: 1.05-6.73), pancreatic portal hypertension (OR = 2.81, 95%CI: 1.06-7.45), and cystic-solid (OR = 2.51, 95%CI: 1.34-4.69) or solid lesions (OR = 1.91, 95%CI: 1.06-3.44) were independently associated with TO failure (all P < 0.05). The derived nomogram exhibited modest discrimination and calibration when assessed in both the training and validation datasets.
CONCLUSION
The proposed LDP-specific definition of TO is feasible and discriminative, and the developed nomogram provides an objective tool for individualized risk assessment.
Core Tip: We established a laparoscopic distal pancreatectomy-specific textbook outcome composite absence of grade B/C postoperative pancreatic fistula, grade B/C post-pancreatectomy hemorrhage, Clavien-Dindo ≥ III morbidity, 30-day readmission, and in-hospital or 30-day mortality as a standardized quality indicator for distal pancreatic resection. Among 405 consecutive patients, textbook outcome was attained in 70.6%; female sex enhanced achievement, whereas pre-operative endoscopic ultrasound-guided fine-needle aspiration, pancreatic portal hypertension, and cystic-solid/solid pathology predicted failure. An internally validated nomogram is provided for individual pre-operative risk counselling.
