Background Composite outcomes may more accurately reflect patient and provider expectations around optimal care. We sought to determine the impact of achieving a so‐called “textbook oncologic outcome” (TOO) among patients undergoing resection of pancreatic adenocarcinoma (PDAC). Methods Patients undergoing pancreaticoduodenectomy (PD) for PDAC between 2006 and 2016 were identified in the National Cancer Database (NCDB). TOO was defined by: margin negative resection, compliant lymph node evaluation, no prolonged length‐of‐stay, no 30‐day readmission/mortality, and receipt of adjuvant chemotherapy. Factors associated with TOO and overall survival (OS) were evaluated using multivariable logistic and Cox regression models, respectively. Results Among 18 608 patients who underwent PD at 782 hospitals, many patients successfully achieved certain TOO factors such as R0 margin (77.9%) and no 30‐day mortality (96.9%), while other TOO criteria such as receipt of adjuvant therapy (48.2%) were achieved less frequently. Overall, only 3124 (16.8%) patients achieved a TOO. Factors associated with lower odds of TOO included: older age, Black race, Medicaid insurance, Community facility, and low PD facility (<20 PD/y) (all P < .05). Achievement of a TOO was associated with lower risk of mortality (HR 0.74; 95% CI, 0.70‐0.77). Conclusions While TOO was associated with improved long‐term survival, TOO was only achieved in 16.8% of patients undergoing PD.

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Coordination of two [Ru(bipy)(2)Cl](+) moieties (where bipy = 2,2'-bipyridine) to the pyridyl nitrogens in the 5,10-positions of meso-5,10,15-(4-pyridyl)-20-(pentafluorophenyl)porphyrin gives the diruthenium porphyrin complex I. Insertion of nickel(II), copper(II), and zinc(II) into the porphyrin center gives the complexes II-IV, respectively. Electronic transitions associated with the ruthenium porphyrin include an intense Soret band and four less intense Q-bands in the visible region of the spectrum. An intense π-π* transition in the UV region associated with the bipyridyl groups and a metal-to-ligand charge transfer (MLCT) band appearing as a shoulder to the Soret band are also observed. A shift of the Soret band and collapse of the Q-bands into one band is observed upon insertion of the metal ions into the porphyrin center. Electrochemical properties associated with the complexes include a redox couple in the cathodic region attributed to the porphyrin and a redox couple in the anodic region due to the Ru(III/II) couple. DNA titrations of the complexes indicate that they interact strongly with DNA potentially through an intercalation mechanism. Irradiation of aqueous solutions of the complexes and supercoiled DNA at a 5:1 base pair to complex ratio with visible light above 400 nm shows nicking of DNA for the nickel(II) and copper(II) complexes and photocleavage of DNA for the zinc(II) complex. Cell studies with dermal skin (normal) fibroblast and melanoma cells indicate that the free base porphyrin(I) is toxic to both normal and melanoma cells, while the nickel(II) and copper(II) complexes, II and III, are non-toxic to both cell lines when irradiated with a tungsten lamp. The zinc(II) complex, IV, is non-toxic to normal cells but toxic to melanoma cells when irradiated under the same conditions.

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