Published online May 28, 2026. doi: 10.3748/wjg.v32.i20.119062
Revised: January 31, 2026
Accepted: February 26, 2026
Published online: May 28, 2026
Processing time: 122 Days and 22 Hours
The concept of textbook oncologic outcome (TOO), serving as an integrated composite measure, has emerged to evaluate the overall standard of oncologic care. Its utilization now spans various cancer types, supported by growing evidence linking successful TOO achievement to improved long-term patient survival. However, the role of TOO in pancreatic cancer patients undergoing pancreaticoduodenectomy (PD), particularly via open surgery, remains unclear. Additionally, differences in TOO achievement rates and associated factors between open PD (OPD) and laparoscopic PD (LPD) have not been systematically investigated.
To compare the achievement rates and influencing factors of TOO between OPD and LPD.
We retrospectively reviewed patient records from our institution for those who received PD due to tumors located in the pancreatic head from January 2012 to June 2022. Patients meeting specific criteria were enrolled and grouped according to the type of surgical approach employed, either LPD or OPD. Propensity score matching techniques were employed to control for baseline differences between cohorts. Subsequently, multivariate logistic regression analysis was performed to identify factors independently associated with achieving TOO.
Overall, 78 patients achieved TOO, including 45 in the LPD group and 33 in the OPD group (P = 0.112). Achieving TOO was associated with significantly longer median overall survival in both groups (all P < 0.05). In the LPD group, independent risk factors negatively associated with TOO were high Clavien-Dindo grade [odds ratio (OR) = 0.22; 95% confidence interval (CI): 0.07-0.68] and prolonged postoperative hospital stay (OR = 0.94; 95%CI: 0.88-1.00). In the OPD group, independent risk factors included elevated aspartate aminotransferase (OR = 0.39; 95%CI: 0.16-0.92) and high Clavien-Dindo grade (OR = 0.32; 95%CI: 0.13-0.78) (all P < 0.05).
TOO achievement did not differ between LPD and OPD but was strongly correlated with superior long-term survival, with distinct risk factors across surgical approaches.
Core Tip: As an emerging composite endpoint, textbook oncologic outcome (TOO) reflects both the quality and effectiveness of oncologic surgery, although its role in pancreaticoduodenectomy (PD) has not been fully elucidated. In this propensity score matching-based analysis, no significant difference in TOO achievement was observed between laparoscopic PD and open PD. Nevertheless, achieving TOO was consistently associated with improved long-term survival regardless of surgical approach. Moreover, the factors influencing TOO attainment differed between surgical strategies, underscoring the impact of postoperative complications, recovery patterns, and hepatic function. These findings support TOO as a meaningful quality indicator and advocate for individualized perioperative strategies to optimize PD outcomes.