Textbook outcome as a predictor of long-term prognosis in ampullary cancer: A retrospective cohort study

doi:10.3748/wjg.122776

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastroenterol. Dec 28, 2026; 32(48): 122776
Published online Dec 28, 2026. doi: 10.3748/wjg.122776

Table 1 Baseline characteristics of patients with or without achieving textbook outcome after pancreaticoduodenectomy, n (%)/median (interquartile range)

Characteristic	Overall (n = 347)	TO (n = 230)	Non-TO (n = 117)	P value
Sex				0.335
Female	189 (54)	130 (57)	59 (50)
Male	158 (46)	100 (43)	58 (50)
Age (years)	58 (51, 64)	58 (51, 64)	58 (51, 64)	0.992
BMI (kg/m²)	21.70 (20.26, 23.64)	21.70 (20.04, 23.54)	21.70 (20.62, 23.64)	0.179
Previous abdominal surgery	113 (33)	75 (33)	38 (32)	> 0.999
Tumor differentiation				0.511
Well	232 (67)	157 (68)	75 (64)
Poor	115 (33)	73 (32)	42 (36)
T-stage				0.117
T1	37 (11)	29 (13)	8 (6.8)
T2	122 (35)	85 (37)	37 (32)
T3a	87 (25)	58 (25)	29 (25)
T3b	90 (26)	53 (23)	37 (32)
T4	11 (3.2)	5 (2.2)	6 (5.1)
N-stage				0.138
N0	209 (60)	147 (64)	62 (53)
N1	106 (31)	63 (27)	43 (37)
N2	32 (9.2)	20 (8.7)	12 (10)
TNM-stage				0.076
IA+IB	124 (36)	93 (40)	31 (26)
IIA	59 (17)	40 (17)	19 (16)
IIB	23 (6.6)	15 (6.5)	8 (6.8)
IIIA	103 (30)	60 (26)	43 (37)
IIIB	38 (11)	22 (9.6)	16 (14)
Perineural invasion	32 (9.2)	19 (8.3)	13 (11)	0.502
Biliary drainage	120 (35)	82 (36)	38 (32)	0.640
CA19-9 > 37 U/mL	209 (60)	134 (58)	75 (64)	0.350
CEA > 5 ng/mL	62 (18)	36 (16)	26 (22)	0.173
Preoperative EUS	49 (14)	31 (13)	18 (15)	0.750
Biliary duct dilatation	263 (76)	173 (75)	90 (77)	0.827
Pancreatic duct dilatation	188 (54)	124 (54)	64 (55)	0.980
Operation method				0.141
OPD	178 (51)	111 (48)	67 (57)
LPD	169 (49)	119 (52)	50 (43)
Operative time (minutes)	320 (260, 390)	290 (260, 370)	330 (270, 390)	0.032^a
EIBL (mL)	150 (60, 350)	150 (80, 350)	150 (50, 350)	0.963
Tumor size (cm)	2.00 (1.50, 3.00)	2.00 (1.50, 3.00)	2.00 (1.50, 3.00)	0.445
Pancreas hardness				0.523
Hard	71 (20)	50 (22)	21 (18)
Intermediate	62 (18)	43 (19)	19 (16)
Soft	214 (62)	137 (60)	77 (66)
Pancreatic anastomosis				0.040^a
End-to-end (invaginated)	34 (9.8)	27 (12)	7 (6.0)
Modified end-to-side (imbedding)	136 (39)	96 (42)	40 (34)
Duct-to-mucosa	177 (51)	107 (47)	70 (60)
Positive resection margin	21 (6.1)	9 (3.9)	12 (10)	0.035^a
Additional organ resection	11 (3.2)	5 (2.2)	6 (5.1)	0.246
Postoperative nasogastric tube removal (days)	4.0 (2.0, 6.0)	4.0 (2.0, 5.0)	4.0 (2.0, 6.0)	< 0.001^a
First oral food intake (days)	6.0 (4.0, 8.0)	5.0 (4.0, 7.0)	7.0 (4.0, 11.0)	0.002^a
First off-bed activity (days)	3.0 (3.0, 5.0)	3.0 (2.0, 5.0)	3.0 (3.0, 5.0)	0.007^a

^aP < 0.05.

TO: Textbook outcome; BMI: Body mass index; TNM: Tumor-node-metastasis; CA19-9: Carbohydrate antigen 19-9; CEA: Carcinoembryonic antigen; EUS: Endoscopic ultrasonography; OPD: Open pancreaticoduodenectomy; LPD: Laparoscopic pancreaticoduodenectomy; EIBL: Estimated intraoperative blood loss.

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Citation: Guo XY, Zhang JZ, Guo T, Huang XR, Zhu DS, Zhang Z, Zheng H, Yu YH, Zhang ZW. Textbook outcome as a predictor of long-term prognosis in ampullary cancer: A retrospective cohort study. World J Gastroenterol 2026; 32(48): 122776
URL: https://www.wjgnet.com/1007-9327/full/v32/i48/122776.htm
DOI: https://dx.doi.org/10.3748/wjg.122776

Guo XY, Zhang JZ, Guo T, Huang XR, Zhu DS, Zhang Z, Zheng H, Yu YH, Zhang ZW. Textbook outcome as a predictor of long-term prognosis in ampullary cancer: A retrospective cohort study. World J Gastroenterol 2026; 32(48): 122776 [DOI: 10.3748/wjg.122776]

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