Impact of Textbook Oncologic Outcome Attainment on Survival After Gastrectomy: A Review of the National Cancer Database

Cibulas, Megan; Avila, Azalia; Mahendra, Ashwin M.; Samuels, Shenae; Gannon, Christopher J.; Llaguna, Omar H.

doi:10.1245/s10434-022-12388-1

Cited by 11 publications

(14 citation statements)

References 19 publications

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“…10 Similarly, a 2022 study by Cibulas et al concluded that of the 34,688 patients identified in the NCDB who had undergone gastrectomy for gastric cancer only 23.8% achieved TOO. 11 Patients who achieved TOO were found to have a statistically significantly improved median OS when compared the non-TOO group (80.5 months vs 35.3 months, P < .001), and TOO attainment was significantly associated with a reduced risk of death (HR = .82; P < .001). 11 Given their findings, as well as that of prior authors, they concluded that an emphasis should be placed on efforts to improve the national TOO attainment rate.…”

Section: Discussionmentioning

confidence: 86%

Impact of Minimally Invasive Approach on Attainment of a Textbook Oncologic Outcome Following Gastrectomy for Gastric Cancer: A Review of the National Cancer Database

Avila,

Cibulas,

Samuels

et al. 2023

The American Surgeon™

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Background Textbook oncologic outcome (TOO) is a composite outcome measure realized when all desired short-term quality metrics are met following an oncologic operation. This study examined whether minimally invasive gastrectomy (MIG) is associated with increased likelihood of TOO attainment. Methods The 2010–2016 National Cancer Database was queried for patients with gastric cancer who underwent gastrectomy. Surgical approach was described as open (OG), laparoscopic (LG), or robotic (RG). TOO was defined as having met five metrics: R0 resection, AJCC compliant lymph node evaluation (n ≥ 15), no prolonged length of stay (< 75th percentile by year), no 30-day readmission, and receipt of guideline-accordant systemic therapy. Results Of 21,015 patients identified, 5708 (27.2%) underwent MIG (LG = 21.9%, RG = 5.3%). Patients who underwent RG were more likely to have met all TOO criteria, and consequently TOO. Logistic regression models revealed that patients undergoing MIG were significantly more likely to attain TOO. MIG was associated with a higher likelihood of adequate LAD, no prolonged LOS, and concordant chemotherapy. Patients who underwent LG and achieved TOO had the highest median OS (86.7 months), while the OG non-TOO cohort experienced the lowest (34.6 months). The median OS for the RG TOO group was not estimable; however, the mortality rate (.7%) was the lowest of the six cohorts. Conclusion RG resulted in a significantly increased likelihood of TOO attainment. Although TOO is associated with increased OS across all surgical approaches, attainment of TOO following MIG is associated with a statistically significantly higher median OS.

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Section: Discussionmentioning

confidence: 86%

Impact of Minimally Invasive Approach on Attainment of a Textbook Oncologic Outcome Following Gastrectomy for Gastric Cancer: A Review of the National Cancer Database

Avila,

Cibulas,

Samuels

et al. 2023

The American Surgeon™

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“…In the present study, 18 In the United States, a relatively low rate of AC reflects low TOO. 19,20 This may be related to postoperative complications, comorbidities, and other factors affecting the patient's general condition. This study revealed that older age ( > 75 years), advanced tumors (pT3/4), and high ASA (3/4) scores had a negative impact on TO and TOO.…”

Section: Discussionmentioning

confidence: 99%

“…Despite increased administration of perioperative treatment over time, POC compliance in European patients with GC remains low 18 . In the United States, a relatively low rate of AC reflects low TOO 19,20 . This may be related to postoperative complications, comorbidities, and other factors affecting the patient’s general condition.…”

Section: Discussionmentioning

confidence: 99%

Textbook Oncological Outcome in European Gastrodata

et al. 2023

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Objective: To assess the rate of textbook outcome (TO) and textbook oncological outcome (TOO) in European population based on Gastrodata registry. Background: TO is a composite parameter assessing surgical quality and strongly correlates with improved overall survival. Following the standard of treatment for locally advanced gastric cancer (GC), TOO was proposed as a quality and optimal multimodal treatment parameter. Methods: TO was achieved when all the following criteria were met: no intraoperative complications, radical resection according to the surgeon, pR0 resection, retrieval of at least 15 lymph nodes, no severe postoperative complications, no reintervention, no admission to the intensive care unit, no prolonged length of stay, no postoperative mortality and no hospital readmission. TOO was defined as TO with addition of perioperative chemotherapy compliance. Results: From the 2558 patients, 1700 were included in the analysis. TO was achieved in 1164 (68.5%) patients. The use of neoadjuvant chemotherapy (OR=1.33, 95%CI: 1.04-1.70) and D2 or D2+ lymphadenectomy (OR=1.55, 95%CI: 1.15-2.10) had a positive impact on TO achievement. Older age (OR=0.73, 95%CI: 0.54-0.94), pT3/4 (OR=0.79, 95%CI: 0.63-0.99), ASA 3/4 (OR=0.68, 95%CI: 0.54-0.86) and total gastrectomy (OR=0.56, 95%CI: 0.45-0.70), had negative impact on TO achievement. TOO was achieved in 388 (22.8%) patients. Older age (OR=0.37, 95%CI: 0.27-0.53), pT3-pT4 (OR=0.52, 95%CI: 0.39-0.69) and ASA 3-4 (OR=0.58, 95%CI: 95%CI: 0.43-0.79) had negative impact on TOO achievement. Conclusion: Despite successively improved surgical outcomes, stage‐appropriate chemotherapy in adherence to the current guidelines for multimodal treatment of GC remains poor. Further implementation of oncologic quality metrics should include greater emphasis on perioperative chemotherapy and adequate lymphadenectomy.

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“…Ten quality outcomes were described and the rate where all 10 were achieved was assessed, with operative mortality being one component. Since that report the rate of achievement of a TBO has been shown to assess hospital performance 6,7 with the higher rates achieved in high‐volume centres and associated with improved cancer survival 6–9 . Using population data in Queensland, assessment of outcomes from complex upper gastro‐intestinal cancer was made using a modification of the TBO labelled ‘High Quality Surgery’ (HQS) 10 .…”

Section: Figmentioning

confidence: 99%

“…Since that report the rate of achievement of a TBO has been shown to assess hospital performance 6,7 with the higher rates achieved in high-volume centres and associated with improved cancer survival. [6][7][8][9] Using population data in Queensland, assessment of outcomes from complex upper gastro-intestinal cancer was made using a modification of the TBO labelled 'High Quality Surgery' (HQS). 10 This included 6 of the 10 Dutch TBO elements.…”

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confidence: 99%

Quality indicators in surgery for cancer: not just the operation

Smithers

2023

ANZ Journal of Surgery

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Impact of Textbook Oncologic Outcome Attainment on Survival After Gastrectomy: A Review of the National Cancer Database

Cited by 11 publications

References 19 publications

Impact of Minimally Invasive Approach on Attainment of a Textbook Oncologic Outcome Following Gastrectomy for Gastric Cancer: A Review of the National Cancer Database

Impact of Minimally Invasive Approach on Attainment of a Textbook Oncologic Outcome Following Gastrectomy for Gastric Cancer: A Review of the National Cancer Database

Textbook Oncological Outcome in European Gastrodata

Quality indicators in surgery for cancer: not just the operation

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