Textbook Oncologic Outcome Summarizes the Perioperative Cancer Journey, but Should it be used to Judge Hospitals?

Auer, Rebecca C.; Balaa, Fady

doi:10.1245/s10434-021-10714-7

Cited by 9 publications

(7 citation statements)

References 12 publications

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“…However, the indicators included in the de nition of TO in this setting vary widely. While the original study by Kolfschoten [2] used the variables hospital survival, radical resection, no reintervention, no ostomy, no adverse effects, and no prolonged hospital stay, the other studies also include variables related either to an ideal oncological result -i.e., R0 resections, an acceptable number of lymph nodes isolated or adequate adjuvant treatment -or to diagnostic procedures or morbidity and mortality -i.e., pre-or postoperative colonoscopy, surgery < 6 weeks after diagnosis, and mortality or readmission in the early postoperative period [10,14,15,17].…”

Section: Discussionmentioning

confidence: 99%

“…Those authors concluded that TO can be used to compare care quality at different cancer centers. On the other hand, expert opinions such as the article by Auer and Balaa [17] question its use in interhospital comparisons given the possible tendency to select patients likely to achieve better clinical results and thus limit the inclusion of high-risk patients. In his initial description, Kolfschoten [2] applied TO in low-risk patients, but as the use of the concept has spread to other settings, patients of all degrees of severity have been included.…”

Section: Discussionmentioning

confidence: 99%

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Textbook outcome in colon carcinoma: implications for overall survival and disease-free survival

Rubio-García

Barberá

Tudela

et al. 2023

Langenbecks Arch Surg

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BACKGROUND:Textbook outcome (TO) is a multidimensional quality management tool that uses a set of traditional surgical measures to re ect an "ideal" surgical result for a particular pathology. The aim of the present study is to record the rate of TO in patients undergoing elective surgery for colon cancer. MATERIAL AND METHODS:Retrospective study of all patients undergoing scheduled colon cancer surgery at a Spanish university hospital from September 2012 to August 2016. Patients with rectal cancer were excluded. The variables included in the de nition of TO were: R0 resection, number of isolated nodes ≥12, no Clavien-Dindo ≥IIIa complications, no prolonged stay, no readmissions, and no mortality in the rst 30 days. RESULTS:Five hundred and sixty-four patients were included in the study. TO was achieved in 49.8%. The sample had a mean age of 69 ± 11 years, and 60% were male. Female sex (OR 1.61; 95% CI 2.30-1.13), T3 and T4 classi cation (OR 2.50, and OR 2.55, and laparoscopic approach (OR 1.53, 95% CI 2.33-1.00) were independent factors that were signi cantly associated with achieving a TO. Patients who achieved TO had higher overall survival (p=0.008) than those who did not. However, with regard to disease-free survival, no statistically signi cant differences were found (p=0.303). CONCLUSION:TO is a useful, easy-to-interpret management tool for measuring oncological results and for predicting patient survival.The study was registered in the public accessible database clinicaltrials.gov with the ClinicalTrials.gov ID: NCT05675904. Public release date: 01/05/2023.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Textbook outcome in colon carcinoma: implications for overall survival and disease-free survival

Rubio-García

Barberá

Tudela

et al. 2023

Langenbecks Arch Surg

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“…An indirect effect of emphasizing TOO as a metric for hospital quality may cause even more pressure for health systems to adopt more stringent patient selection, pushing some higher risk patients to become ineligible for curative surgery. 35 In their analysis, Hoehn et al conclude that intrinsic qualities of SNHs lead to poorer outcomes because of diminished hospital resources rather than patient factors. 17 As demonstrated in this study, there is a residual effect of the institution itself on survival after controlling for patient factors.…”

Section: Discussionmentioning

confidence: 99%

Impact of safety‐net hospital burden on achievement of textbook oncologic outcomes following resection in for stage I–IV colorectal cancer

Wong,

Victorino,

Miraflor

et al. 2023

Journal of Surgical Oncology

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Background and ObjectivesTextbook oncologic outcome (TOO) is a benchmark for high‐quality surgical cancer care but has not been studied at safety‐net hospitals (SNH). The study sought to understand how SNH burden affects TOO achievement in colorectal cancer.MethodsThe National Cancer Database was queried for colorectal cancer patients who underwent resection for stage I‐III plus stage IV with liver‐only metastases (2010–2019). TOO was defined as R0 resection, AJCC‐compliant lymphadenectomy (>12 nodes), no prolonged LOS, no 30‐day mortality/readmission, and receipt of stage‐appropriate adjuvant chemotherapy.ResultsOf 487,195 patients, 66.7% achieved TOO. Lower achievement was explained by adequate lymphadenectomy (87.3%), non‐prolonged LOS (76.3%), and receipt of adjuvant chemotherapy in stage III (60.3%) and IV (54.1%). Treatment at high burden hospitals (HBH, >10% Medicaid/uninsured) was a predictor of non‐TOO (Stage I/II: OR 0.83, III: OR 0.86, IV: OR 0.83; all p < 0.001). Achieving TOO was associated with decreased mortality (Stage I/II: HR 0.49, III: HR 0.48, IV: HR 0.57; all p < 0.001), and HBH treatment was a predictor of mortality (Stage I/II: HR 1.09, III: HR 1.05, IV: HR 1.07; all p < 0.05).ConclusionsTreatment at higher SNH burden hospitals was associated with less frequent TOO achievement and increased mortality. Quality improvement targets include receipt of adjuvant chemotherapy and avoidance of prolonged LOS.

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“…Advancements in multimodal colorectal cancer treatments have led to improved outcomes, but significant survival differences still exist [ 3 , 4 , 5 ]. While various indicators have been used to compare hospitals, treatment protocols, and surgeons, they do not fully reflect the complexity of perioperative care [ 6 , 7 ]. Patients have also expressed a preference for concise, summarizing measures while evaluating individual surgeons and hospitals [ 8 ].To address this, a composite measure called “Textbook Outcome” (TO) has been developed, which encompasses all desirable outcomes and requires patients to meet all critical quality-of-care parameters for the procedure [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Achieving Textbook Outcomes in Colorectal Cancer Surgery Is Associated with Improved Long-Term Survival: Results of the Multicenter Prospective Cohort Study

Kryzauskas,

Bausys,

Abeciunas

et al. 2024

JCM

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Background: The outcomes of patients with colorectal cancer greatly depend on the quality of their surgical care. However, relying solely on a single quality indicator does not adequately capture the multifaceted nature of modern perioperative care. A new tool—“Textbook Outcome” (TO)—has been suggested to provide a comprehensive evaluation of surgical quality. This study aims to examine how TO affects the long-term outcomes of colorectal cancer patients who are scheduled for surgery. Methods: The data of all patients undergoing elective colorectal cancer resection with primary anastomosis at two major cancer treatment centers in Lithuania—Vilnius University Hospital Santaros Klinikos and National Cancer Institute—between 2014 and 2018 were entered into the prospectively maintained database. The study defined TO as a composite quality indicator that incorporated seven parameters: R0 resection, retrieval of ≥12 lymph nodes, absence of postoperative complications during the intrahospital period, hospital stay duration of fewer than 14 days, no readmission within 90 days after surgery, no reinterventions within 30 days after surgery, and no 30-day mortality. Long-term outcomes between patients who achieved TO and those who did not were compared. Factors associated with failure to achieve TO were identified. Results: Of the 1524 patients included in the study, TO was achieved by 795 (52.2%). Patients with a higher ASA score (III-IV) were identified to have higher odds of failure to achieve TO (OR 1.497, 95% CI 1.203–1.863), while those who underwent minimally invasive surgery had lower odds for similar failure (OR 0.570, 95% CI 0.460–0.706). TO resulted in improved 5-year overall—(80.2% vs. 65.5%, p = 0.001) and disease-free survival (76.6% vs. 62.6%; p = 0.001) rates. Conclusions: Elective colorectal resections result in successful TO for 52.5% of patients. The likelihood of failure to achieve TO is increased in patients with a high ASA score, while minimally invasive surgery is associated with higher TO rates. Patients who fail to achieve successful surgical outcomes experience reduced long-term outcomes.

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Textbook Oncologic Outcome Summarizes the Perioperative Cancer Journey, but Should it be used to Judge Hospitals?

Cited by 9 publications

References 12 publications

Textbook outcome in colon carcinoma: implications for overall survival and disease-free survival

Textbook outcome in colon carcinoma: implications for overall survival and disease-free survival

Impact of safety‐net hospital burden on achievement of textbook oncologic outcomes following resection in for stage I–IV colorectal cancer

Achieving Textbook Outcomes in Colorectal Cancer Surgery Is Associated with Improved Long-Term Survival: Results of the Multicenter Prospective Cohort Study

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