Impact of Ideal Outcome on Survival and Treatment Continuity After Pancreatoduodenectomy for Resectable Pancreatic Head Cancer.

BACKGROUND: Ideal outcome (IO) after pancreatoduodenectomy (PD) is a harmonized composite perioperative quality measure, but its association with long-term oncological outcomes remains unknown. METHODS: We retrospectively analyzed 138 consecutive patients undergoing PD for resectable pancreatic head cancer from 2019 to 2024. IO was defined as the absence of in-hospital mortality, severe complications, clinically relevant postoperative pancreatic fistula, reoperation, prolonged hospital stay, and unplanned readmission. Overall survival (OS), recurrence-free survival, and post-recurrence survival were compared by IO status. RESULTS: IO was achieved in 80 patients (58%). The 5 years OS was 74.7% in the IO achievement group versus 46.0% in the non-achievement group (p = 0.011); 3 years recurrence-free survival was 59.7% versus 49.7% (p = 0.151). On multivariable analysis, IO achievement was independently associated with favorable OS (p = 0.036). IO achievement was also associated with higher adjuvant chemotherapy initiation (86.1% vs. 67.2%; p = 0.015), earlier initiation (postoperative day 44 vs. 56; p < 0.001), and superior postoperative nutritional and inflammatory profiles. At recurrence, IO achievement was associated with longer post-recurrence survival (median 15 vs. 6 months; p = 0.009). CONCLUSIONS: IO achievement might serve as a composite marker reflecting physiological reserve after PD for resectable pancreatic head cancer.