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Incidence and impact of Textbook Outcome among patients undergoing resection of pancreatic neuroendocrine tumors: Results of the US Neuroendocrine Tumor Study Group
Author(s) -
Heidsma Charlotte M.,
Hyer Madison,
Tsilimigras Diamantis I.,
Rocha Flavio,
Abbott Daniel E.,
Fields Ryan,
Smith Paula M.,
Poultsides George A.,
Cho Clifford,
Maithel Shishir K.,
Pawlik Timothy M.
Publication year - 2020
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.25900
Subject(s) - medicine , neuroendocrine tumors , incidence (geometry) , hazard ratio , enucleation , percentile , pancreatectomy , gastroenterology , resection , surgery , confidence interval , statistics , physics , mathematics , optics
Abstract Background and Objectives We sought to define the incidence and impact of Textbook Outcome (TO) on disease‐free survival [DFS] among patients undergoing resection of pancreatic neuroendocrine tumors (PNET). Methods Patients undergoing resection of a PNET between 2000 and 2016 were identified using a multi‐institutional database. TO was defined as no postoperative severe complications (Clavien‐Dindo grade ≥ III), no 90‐day mortality, no prolonged length‐of‐hospital stay (LOS) (ie, > 75th percentile), no 90‐day readmission after discharge, and R0 resection. The 5‐year DFS was calculated and the association with TO was examined. Results Among 821 patients with a PNET, median tumor size was 2.1 cm (IQR 1.4‐14.6). Resection consisted of pancreatoduodenectomy (PD) (n = 231, 28.1%), distal pancreatectomy (DP) (n = 492, 59.9%), and enucleation (EN) (n = 98, 11.9%). Overall TO rate was 49.3% (n = 405). The incidence of TO varied by procedure type (PD: 32.5% vs DP: 56.7% vs EN: 52.0%; P < .001). After adjusting for all competing factors, achievement of a TO was independently associated with improved DFS (hazard ratio: 0.54, 95% CI, 0.35‐0.81; P = .003). Conclusions Only one in two patients undergoing resection of a PNET achieved a TO, which varied markedly based on procedure type. Achievement of a TO was associated with improved DFS.