# Development of a Modified Textbook Outcome in Evaluating Robot‐Assisted Middle Pancreatectomy: A Real‐World Study of RMP Surgery in a High‐Volume Pancreatic Disease Center

## TL;DR

This study introduces a new way to measure successful robot-assisted middle pancreatectomy surgeries using a modified textbook outcome metric.

## Contribution

The paper introduces the modified textbook outcome (mTO) as a novel metric for evaluating outcomes in robot-assisted middle pancreatectomy.

## Key findings

- The modified textbook outcome rate was 73.68% among 209 patients.
- Patients with mTO had significantly shorter hospital stays.
- Improvement in surgical outcomes was observed after passing the learning curve.

## Abstract

We aimed to, for the first time, assess the value of modified textbook outcome (mTO) in robot‐assisted middle pancreatectomy (RMP) procedures.

Pancreatic fistula remains to be the major complication after RMP. Textbook outcome (TO) is introduced to capture the most desirable surgical outcomes. The value of TO in RMP surgery remains unknown.

All patients who underwent RMP in our center from 2010 to 2023 were enrolled in the study. Baseline characteristics, operative outcomes, and oncological outcomes were collected and analyzed. Textbook outcome was calculated separately for each patient and analyzed.

The mTO was defined by the absence of modified post‐operative pancreatic fistula (mPOPF), postpancreatectomy hemorrhage (PPH), severe complications (Clavien–Dindo ≥ III), readmission, and in‐hospital mortality (IHM). The overall mTO rate and mPOPF rate of 209 patients were 73.68% and 15.79%, respectively. Patients who achieved modified textbook outcomes have shorter post‐operative hospitalization days (median (IQR), 17 (9) vs. 34 (26), p < 0.001). Passing the learning curve leads to a reduction of the mPOPF rate and an increase of the mTO rate.

Modified textbook outcome is a practical metric for evaluating ideal surgical outcomes in RMP surgery. Follow‐up multi‐center clinical research is necessary to evaluate this indicator even further.