Textbook outcome contributes to long-term prognosis in elderly colorectal cancer patients

Abstract

Textbook outcome (TO) has been used to de ne achievement of multiple "ideal" or "optimal" surgical and postoperative quality measures from the patient's perspective. However, TO has not been reported for their impact on survival in elderly, including CRC surgery. This study determined whether TO is associated with long-term outcomes after curative colorectomy in patients with colorectal cancer (CRC). MethodsPatient who underwent curative surgery over 75 years old for CRC between March 2005 and December 2016. TO included ve separate: surgery within 6 weeks, radical resection, Lymph node (LN) yield ≥ 12, no stoma, and no adverse outcome. When all 5 short-term quality of care parameters were realized, TO was achieved (TO). If any one of the 5 parameters was not met, the treatment was not considered TO (nTO). ResultsTO was realized in 80 patients (43.0%). Differences in surgical-related characteristics, and pathological characteristics according to TO had no statistically signi cant differences in baseline characteristics, except for Lymph node dissection. The Kaplan-Meier curves for OS and RFS association between TO and nTO had signi cantly poor 5-year OS and 5-year RFS compared with the TO groups (OS, 77.8% vs. 60.8%, P < 0.01; RFS, 69.6% vs. 50.8%, P = 0.01). In the multivariate analysis, nTO was an independent predictive factor for worse OS (HR, 2.04; 95% con dence interval (CI), 1.175-3.557; P = 0.01) and RFS (HR, 1.72; 95% CI, 1.043-2.842; P = 0.03). ConclusionsTO can be a useful predictor for postoperative morbidity and prognosis after curative colorectomy for CRC.

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.…”

“…example, studies focusing on the elderly patients found lower textbook outcome values (43-68%)[10,11,13,19,23]; however, Taffurelli et al found that biological age did not correlate as well as patient frailty. In this study, a score ≥ 2 on the Flemish version of the Triage Risk Screening Tool (fTRST) had an increased risk of worse postoperative outcomes (Odds Ratio 1.97; 95% CI: 1.23-3.16)[13].…”

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

“…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 ]. However, in high-risk low anastomosis cases, a preventive ileostomy is typically instituted as a standard preventive measure against anastomotic leakage or to minimize potential damage from such leakage.…”