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Purposes <p>The Textbook Outcome (TBO) is a novel quality measure in pancreatic surgery, reflecting an ideal surgical outcome. This study aimed to identify the risk factors associated with achieving a TBO after pancreaticoduodenectomy.</p> Methods <p>We retrospectively reviewed the records of 215 patients who underwent pancreaticoduodenectomy between 2016 and 2023. A TBO was defined as the absence of all six of the following parameters: 30-day mortality, readmission, postoperative pancreatic fistula, bile leakage, post-pancreatectomy hemorrhage, and severe complications (Clavien–Dindo grade ≥ III). Logistic regression was used to evaluate the impact of various factors, including nutritional status and body composition, on TBO achievement.</p> Results <p>A TBO was achieved in 123 (57.2%) patients. There were no cases of 30-day mortality reported. A multivariate analysis identified age ≥ 75 years, a soft pancreas, malnutrition as assessed by the GLIM criteria, and a high visceral fat area/skeletal muscle area ratio (VFA/SMA ratio) as significant risk factors for not achieving a TBO. Additionally, patients who achieved a TBO had a significantly better overall survival than those who did not achieve a TBO.</p> Conclusions <p>This study underscores the importance of evaluating the nutritional status and body composition to improve surgical quality. Optimizing these factors preoperatively may support the achievement of a Textbook Outcome and improve the prognosis following pancreaticoduodenectomy.</p>

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Significance of the nutritional and body composition status for predicting a postoperative Textbook Outcome after pancreaticoduodenectomy

  • 期刊论文

  • 发表日期：

    2025年11月24日

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  • Ryosuke Fukushima,
  • Kenichiro Araki,
  • Takahiro Shoda,
  • Takayuki Okuyama,
  • Takaomi Seki,
  • Ryo Muranushi,
  • Kouki Hoshino,
  • Kei Hagiwara,
  • Shunsuke Kawai,
  • Mariko Tsukagoshi,
  • Takamichi Igarashi,
  • Norio Kubo,
  • Ken Shirabe

摘要

Purposes

The Textbook Outcome (TBO) is a novel quality measure in pancreatic surgery, reflecting an ideal surgical outcome. This study aimed to identify the risk factors associated with achieving a TBO after pancreaticoduodenectomy.

Methods

We retrospectively reviewed the records of 215 patients who underwent pancreaticoduodenectomy between 2016 and 2023. A TBO was defined as the absence of all six of the following parameters: 30-day mortality, readmission, postoperative pancreatic fistula, bile leakage, post-pancreatectomy hemorrhage, and severe complications (Clavien–Dindo grade ≥ III). Logistic regression was used to evaluate the impact of various factors, including nutritional status and body composition, on TBO achievement.

Results

A TBO was achieved in 123 (57.2%) patients. There were no cases of 30-day mortality reported. A multivariate analysis identified age ≥ 75 years, a soft pancreas, malnutrition as assessed by the GLIM criteria, and a high visceral fat area/skeletal muscle area ratio (VFA/SMA ratio) as significant risk factors for not achieving a TBO. Additionally, patients who achieved a TBO had a significantly better overall survival than those who did not achieve a TBO.

Conclusions

This study underscores the importance of evaluating the nutritional status and body composition to improve surgical quality. Optimizing these factors preoperatively may support the achievement of a Textbook Outcome and improve the prognosis following pancreaticoduodenectomy.