The textbook outcome of pancreaticoduodenectomy for adenocarcinoma of the pancreas in a high-volume centre.

Background: Pancreatic adenocarcinoma remains a leading cause of cancer-related mortality, with only 15-20% of patients eligible for resection at diagnosis. Pancreaticoduodenectomy (PD) is the standard surgical treatment, yet achieving optimal outcomes is challenging. Textbook Outcome (TO), a composite measure of quality, has emerged as a superior indicator of surgical success compared to individual parameters. This study evaluates TO in PD for pancreatic adenocarcinoma at a high-volume center and its impact on survival. Methods: This was a retrospective analysis conducted at a tertiary cancer center. TO was defined by negative resection margins, ≥12 lymph nodes retrieved, ICU stay <72 h, hospital stay ≤14 days, no readmission within 30 days, no major complications (Clavien-Dindo grade ≥3), and no postoperative pancreatic fistula grade B or C. Patients who underwent pancreaticoduodenectomy for adenocarcinoma pancreas were included. Patients with incomplete data for TO were excluded. Results: A total of 269 patients were included. Complete TO was achieved in 56.9% of patients. Most achieve outcome was negative margins (R0) in 94.8%, and ≥12 lymph nodes were retrieved in 92.6%. Least achieved outcome was hospital stays >14 days in 85%. Overall Survival in patients achieving TO vs those who did not achieved TO was 49 ± 1 month vs 40 ± 2 months respectively. ( Conclusion: Our tertiary cancer center demonstrated better TO rates compared to international published literature, reinforcing the importance of structured quality metrics in pancreatic surgery. TO serves as a robust predictor of long-term survival and should be integrated into surgical audits to enhance patient-centered care.