Textbook Outcome and Survival in Patients With Gastric Cancer

Abstract

Objective: To examine the association between Textbook Outcome (TO)—a new composite quality measurement—and long-term survival in gastric cancer surgery. Background: Single-quality indicators do not sufficiently reflect the complex and multifaceted nature of perioperative care in patients with gastric adenocarcinoma. Methods: All patients undergoing gastrectomy for nonmetastatic gastric adenocarcinoma registered in the Population Registry of Esophageal and Stomach Tumours of Ontario (PRESTO) between 2004 and 2015 were included. TO was defined according to negative margins; >15 lymph nodes sampled; no severe complications; no re-interventions; no unplanned ICU admission; length of stay ≤21 days; no 30-day readmission; and no 30-day mortality. Three-year survival was estimated using the Kaplan-Meier method. A marginal multivariable Cox proportional-hazards model was used to estimate the association between achieving TO metrics and long-term survival. E-value methodology was used to assess for risk of residual confounding. Results: Of the 1836 patients included in this study, 402 (22%) achieved all TO metrics. TO patients had a higher 3-year survival rate compared to non-TO patients (75% vs 55%, log-rank P < 0.001). After adjustments for covariates and clustering within hospitals, TO was associated with a 41% reduction in mortality (adjusted hazards ratio 0.59, 95% confidence interval 0.48, 0.72, P < 0.001). These results were robust to potential residual confounding. Conclusions: Achieving TO is strongly associated with improved long-term survival in gastric cancer patients and merits further focus in surgical quality improvement efforts.

Textbook outcome and survival of robotic versus laparoscopic total gastrectomy for gastric cancer: A propensity score matched cohort study

“…In multivariable analysis, the operative method was not a prognostic factor for survival, whereas achieving textbook outcome was a prognostic factor for survival. Western studies also demonstrated that textbook outcome is strongly associated with longterm survival in gastric cancer surgery [8,9]. Therefore, the achievement of textbook outcome was signi cantly related to the improvement of survival rate, suggesting that the quality of surgery plays an important role in the survival of gastric cancer patients regardless of the operative method.…”

“…Unlike standard surgical quality measures, textbook outcome integrates metrics for oncologically sound surgical treatment, and metrics for measuring clinical events (void of complications and prolonged admissions). Thus, textbook outcome is a helpful measure in evaluating the quality of gastrectomy [9]. To the best of our knowledge, this study is the rst to evaluate the short-term outcomes of RTG compared with those of LTG for patients with gastric cancer using textbook outcome.…”

“…In 2017, the Dutch Upper Gastrointestinal Cancer Audit group developed a composite measure de ned as textbook outcome that combined 10 outcome parameters to assess the quality of surgical care for gastric cancer [6]. Several studies have reported that textbook outcome can be used as the standard for optimisation of care and is associated with long-term survival in patients with gastric cancer [7][8][9][10]. Additionally, textbook outcome has been applied to comparisons of quality across surgical practices and institutions in various elds, such as colon, oesophagus, liver, and pancreatic cancers [7,[11][12][13].…”

Current Trends in Volume and Surgical Outcomes in Gastric Cancer

“…In 2022, the same group concluded that achieving TO is strongly associated with improved long-term survival in 1836 gastric cancer patients, with a 41% reduction in 3-year mortality ( p < 0.001) [ 131 ].…”

Textbook Outcome Following Liver Transplantation

“…Few studies have explored the incidence and value of TBO in cancer [14, 16–19] and noncancer [20, 21] surgeries; and more recently, this has been studied in the setting of liver surgery [22–24].…”