Published online Dec 28, 2026. doi: 10.3748/wjg.122776
Revised: June 18, 2026
Accepted: June 29, 2026
Published online: December 28, 2026
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Ampullary cancer (AC) is a rare gastrointestinal malignancy originating from the ampulla of Vater, and pancreaticoduodenectomy (PD) represents the standard curative treatment. Given the low incidence of this disease, the determinants of long-term survival have not been fully characterized. Textbook outcome (TO), a composite metric of perioperative treatment quality, has emerged as an important benchmark for assessing postoperative outcomes. However, whether TO achi
To evaluate the rate of TO achievement and its prognostic value for long-term sur
This retrospective cohort study consecutively enrolled 347 patients with AC who underwent PD at Tongji Hospital between January 2012 and December 2022. Survival outcomes were analyzed using Kaplan-Meier curves. Cox proportional hazards models were applied to assess the association between TO achievement and overall survival (OS) as well as disease-free survival (DFS). In addition, 1:1 propensity score matching was performed to compare differences in TO achievement rates between laparoscopic and open PD.
Among 347 patients with AC who underwent PD, 230 (66.3%) achieved TO. The component with the lowest achievement rate was “absence of severe complications (Clavien-Dindo ≥ III)” (84.1%). The median OS was 64.2 months [95% confidence interval (CI): 50.5-93.9], and the median DFS was 44.3 months (95%CI: 33.9-57.9). Recurrence occurred in 119 patients (34.2%). The superior mesenteric artery nodal region was the most common site of locoregional recurrence, whereas the liver was the predominant site of distant metastasis. TO achievement was associated with better OS (hazard ratio = 0.61, 95%CI: 0.44-0.84, P = 0.002) and showed a borderline association with improved DFS (hazard ratio = 0.75, 95%CI: 0.56-0.99, P = 0.044). Advanced T/N stage, perineural invasion, elevated carbohydrate antigen 19-9 (> 37 U/mL), and positive surgical margins were independently associated with worse OS and DFS, while poor tumor differentiation independently predicted worse OS. No statistically significant difference in TO achievement was observed between laparoscopic and open PD after propensity score matching.
In patients with AC undergoing PD, TO achievement reflects optimal perioperative care and is associated with improved long-term outcomes. Given its dual value in quality assessment and prognostic stratification, improving TO achievement rates should be considered a key target for surgical quality improvement in PD.
Core Tip: This retrospective cohort study of 347 patients with ampullary cancer demonstrated that achieving textbook outcome (TO) following pancreaticoduodenectomy was associated with improved long-term survival. Additionally, propensity score matching revealed no statistically significant difference in TO achievement between the laparoscopic and open approaches. Given its dual value as both a comprehensive perioperative quality metric and long-term prognostic indicator, enhancing TO achievement rates should be prioritized as a central objective in pancreaticoduodenectomy-specific quality improvement initiatives.