Textbook outcomes and influencing factors after laparoscopic pancreatoduodenectomy for pancreatic ductal adenocarcinoma in a high-volume center

Background This study aimed to evaluate textbook outcome (TO) and identify its independent predictive factors in patients with pancreatic ductal adenocarcinoma (PDAC) following laparoscopic pancreatoduodenectomy (LPD). Methods Patients diagnosed with PDAC who underwent LPD were enrolled. TO was defined as the absence of postoperative pancreatic fistula, bile leakage, post-pancreatectomy hemorrhage, severe complications (Clavien–Dindo grade ≥III), and 30-day readmission or mortality and a postoperative length of stay within the cohort’s 75th percentile. Overall survival (OS) was estimated using the Kaplan–Meier method, and independent predictors of TO were identified through multivariate logistic regression analysis. Results A total of 334 patients were analyzed, 220 in the TO group and 114 in the non-TO group. The TO group presented significantly higher 1-, 3-, and 5-year OS ( p = 0.044). Recurrence-free survival (RFS) was numerically superior, but not statistically significant ( p = 0.140). Multivariate analysis revealed that operative time >360 min, soft pancreatic texture, and main pancreatic duct diameter ≤3 mm were independent risk factors for TO. Conclusion TO after LPD for PDAC is associated with improved OS. Prolonged operation, soft pancreatic texture, and small main pancreatic duct diameter are independent predictors of failure to achieve TO.