Textbook outcome following oesophagectomy for cancer: international cohort study

Abstract

Background Textbook outcome has been proposed as a tool for the assessment of oncological surgical care. However, an international assessment in patients undergoing oesophagectomy for oesophageal cancer has not been reported. This study aimed to assess textbook outcome in an international setting. Methods Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018 to December 2018. Textbook outcome was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. A multivariable binary logistic regression model was used to identify factors independently associated with textbook outcome, and results are presented as odds ratio (OR) and 95 per cent confidence intervals (95 per cent c.i.). Results Of 2159 patients with oesophageal cancer, 39.7 per cent achieved a textbook outcome. The outcome parameter ‘no major postoperative complication’ had the greatest negative impact on a textbook outcome for patients with oesophageal cancer, compared to other textbook outcome parameters. Multivariable analysis identified male gender and increasing Charlson comorbidity index with a significantly lower likelihood of textbook outcome. Presence of 24-hour on-call rota for oesophageal surgeons (OR 2.05, 95 per cent c.i. 1.30 to 3.22; P = 0.002) and radiology (OR 1.54, 95 per cent c.i. 1.05 to 2.24; P = 0.027), total minimally invasive oesophagectomies (OR 1.63, 95 per cent c.i. 1.27 to 2.08; P < 0.001), and chest anastomosis above azygous (OR 2.17, 95 per cent c.i. 1.58 to 2.98; P < 0.001) were independently associated with a significantly increased likelihood of textbook outcome. Conclusion Textbook outcome is achieved in less than 40 per cent of patients having oesophagectomy for cancer. Improvements in centralization, hospital resources, access to minimal access surgery, and adoption of newer techniques for improving lymph node yield could improve textbook outcome.

Textbook outcome as a composite outcome measure in laparoscopic pancreaticoduodenectomy: a multicenter retrospective cohort study

“…Patients without achieving TO had longer LOS compared with achieving TO. However, this TO definition in pancreatic surgery did not include the parameter: ‘no prolonged LOS’, which was included in other surgical procedures 11 , 13 , 22 , 38 – 41 . LOS is an important metric in the quality assessment of surgical procedures and closely related to postoperative complications 1 , 36 , 40 .…”

Risk factors for achieving textbook outcome after laparoscopic duodenum-preserving total pancreatic head resection: a retrospective cohort study

“…Recently, laparoscopic DPPHR-t (LDPPHR-t) has been reported based on the rapid development of laparoscopic pancreaticoduodenectomy 5 , 6 . The single outcome indicator is difficult to accurately evaluate the overall surgical quality of LDPPHR-t. TO is a composite measure indicator that has been applied to several surgical procedures, including colorectal surgery, esophageal surgery, gastric surgery, lung transplantation, liver surgery, and pancreatic surgery 13 – 17 , 24 , 29 – 31 . In 2020, an international expert consensus-based definition of TO in pancreatic surgery was proposed by van Roessel et al .…”

Predictors of textbook outcome following oesophagogastric cancer surgery

“…Furthermore, the definition of severe postoperative complications was amended to Clavien–Dindo III or above to reflect corresponding changes in recent studies. 2 , 13–16 Additionally, the definition of postoperative mortality was defined to 90-day mortality in keeping with other TO papers highlighting that it is a more clinically relevant endpoint. 17 …”

“… 1 Metrics including surgical mortality and complications rates have been utilized to measure the quality of surgical care. 2 These single outcomes have low event rates, limiting statistical power, and do not describe the entire surgical process. 3–5 The concept of a textbook outcome (TO) addresses these limitations, representing a composite measure encompassing intraoperative and postoperative indicators that collectively define an optimal perioperative course.…”