Textbook Oncological Outcomes for Robotic Colorectal Cancer Resections: An Observational Study of Five Robotic Colorectal Units

Abstract

Background: The quality of care of patients receiving colorectal resections has conventionally relied on individual metrics. When discussing with patients what these outcomes mean, they often find them confusing or overwhelming. Textbook oncological outcome (TOO) is a composite measure that summarises all the ‘desirable’ or ‘ideal’ postoperative clinical and oncological outcomes from both a patient’s and doctor’s point of view. This study aims to evaluate the incidence of TOO in patients receiving robotic colorectal cancer surgery in five robotic colorectal units and understand the risk factors associated with failure to achieve a TOO in these patients. Methods: We present a retrospective, multicentric study with data from a prospectively collected database. All consecutive patients receiving robotic colorectal cancer resections from five centres between 2013 and 2022 were included. Patient characteristics and short-term clinical and oncological data were collected. A TOO was achieved when all components were realized—no conversion to open, no complication with a Clavien–Dindo (CD) ≥ 3, length of hospital stay ≤ 14, no 30-day readmission, no 30-day mortality, and R0 resection. The main outcome measure was a composite measure of “ideal” practice called textbook oncological outcomes. Results: A total of 501 patients submitted to robotic colorectal cancer resection were included. Of the 501 patients included, 388 (77.4%) achieved a TOO. Four patients were converted to open (0.8%); 55 (11%) had LOS > 14 days; 46 (9.2%) had a CD ≥ 3 complication; 30-day readmission rate was 6% (30); 30-day mortality was 0.2% (1); and 480 (95.8%) had an R0 resection. Abdominoperineal resection was a risk factor for not achieving a TOO. Conclusions: Robotic colorectal cancer surgery in robotic centres achieves a high TOO rate. Abdominoperineal resection is a risk factor for failure to achieve a TOO. This measure may be used in future audits and to inform patients clearly on success of treatment.

Assessing quality improvement through textbook outcomes in colorectal surgery: A systematic review.

“…The main characteristics of the included studies are shown in Table 1[6,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]. Twelve studies (70.6%) have been published in the last 3 years and 94.1% in the last 5 years.…”

Comparison of survival benefit and safety between surgery following conversion therapy versus surgery alone in patients with surgically resectable hepatocellular carcinoma at CNLC IIb/IIIa stage: a propensity score matching study

“…To further evaluate surgical quality and surgical safety between the two groups, we utilized a comprehensive index called TO, which assesses surgical outcomes from multiple dimensions as a single desirable measure 38 . This widely used index has been extensively applied in abdominal surgery 39 – 41 . Recent studies have shown that achieving TO is associated with improved long-term prognosis in HCC patients undergoing hepatectomy 42 , 43 .…”

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

“…This diversity in parameter selection highlights the ongoing efforts within the medical community to refine the concept of textbook outcomes. Additionally, Azevedo et al’s recent research on robotic colorectal cancer resections formulated TO, based on no conversions to open and no complications with a Clavien–Dindo score of ≥3, LOS of ≤14, radical resection, no 30-day readmission, and no 30-day mortality [ 13 ]. The decision to include only complications with a CD score of ≥3 contrasts with the approach taken in the majority of publications and our data, where all complications were considered in the assessment of TO.…”

“…The decision to include only complications with a CD score of ≥3 contrasts with the approach taken in the majority of publications and our data, where all complications were considered in the assessment of TO. Consequently, the percentage of successfully achieved TO is notably higher, observed in 77.4% of the patients [ 13 ]. Certain authors emphasize the lack of a stoma post-surgery to be a crucial component of TO [ 14 ].…”

“…Length of hospital stay is commonly excluded from textbook outcome definitions due to differences in protocols; for example, certain hospitals conduct cancer staging within the in-patient setting, leading to an extension of the overall duration of hospitalization [ 3 ]. This poses a challenge for comparing different trials as the LOS ranks among the least met in the existing literature [ 13 ]. It is imperative to underscore the necessity for standardizing the definition across different categories, given that a textbook outcome formulated with a more lenient set of five individual parameters may be achieved more frequently than a more stringent formulation composed of seven parameters.…”