Textbook outcome for esophageal cancer surgery: an international consensus-based update of a quality measure

Abstract

Summary Textbook outcome for esophageal cancer surgery is a composite quality measure including 10 short-term surgical outcomes reflecting an uneventful perioperative course. Achieved textbook outcome is associated with improved long-term survival. This study aimed to update the original textbook outcome based on international consensus. Forty-five international expert esophageal cancer surgeons received a personal invitation to evaluate the 10 items in the original textbook outcome for esophageal cancer surgery and to rate 18 additional items divided over seven subcategories for their importance in the updated textbook outcome. Items were included in the updated textbook outcome if ≥80% of the respondents agreed on inclusion. In case multiple items within one subcategory reached ≥80% agreement, only the most inclusive item with the highest agreement rate was included. With a response rate of 80%, 36 expert esophageal cancer surgeons, from 34 hospitals, 16 countries, and 4 continents responded to this international survey. Based on the inclusion criteria, the updated quality indicator ‘textbook outcome for esophageal cancer surgery’ should consist of: tumor-negative resection margins, ≥20 lymph nodes retrieved and examined, no intraoperative complication, no complications Clavien–Dindo ≥III, no ICU/MCU readmission, no readmission related to the surgical procedure, no anastomotic leakage, no hospital stay ≥14 days, and no in-hospital mortality. This study resulted in an international consensus-based update of a quality measure, textbook outcome for esophageal cancer surgery. This updated textbook outcome should be implemented in quality assurance programs for centers performing esophageal cancer surgery, and could standardize quality measures used internationally.

Achieving a Textbook Outcome in Colon Cancer Surgery Is Associated with Improved Long-Term Survival

“…We finally decided on stricter criteria and included Clavien–Dindo grades ≥ II as “major “ complications, which defined “radical resection” as R0 microscopic resection plus ≥ 12 lymph nodes as per guidelines, and grouped prolonged LOS along with 30-day readmission. In any case, this highlights the need for a consensus on Textbook Outcome definition in colorectal surgery, as was the case with oesophageal and liver surgery [ 19 , 20 ]. However, even these Delphi meetings have not completely eliminated this overlapping.…”

Textbook Oncological Outcome in European Gastrodata

“…Recently, TO parameters in esophageal surgery were evaluated and adjusted to the current standard of treatment. 26 Variations in the published definitions of TO and TOO are presented in Table 3.…”

Surgical Therapy of Esophageal Adenocarcinoma—Current Standards and Future Perspectives

“…However, textbook outcome is associated with the ultimate oncological outcome of long-term survival, but in contrast to survival can provide short-loop feedback to surgeons which is essential for behavioral change [ 80 ]. Recently, international consensus was reached; the textbook outcome parameters were updated and overlapping parameters were removed [ 89 ].…”

“…In addition, centralization must be accompanied by transparent outcome assessment via national audits and audited multicenter registries. Ideally, outcomes should be measured with well-defined parameters such as complication, mortality and readmission rates, failure to rescue (percentage of patients with a postoperative complication who die as a result of it), textbook outcome (percentage of patients who meet a series of ideal perioperative outcomes) and benchmarking [ 89 , 103 ]. Therefore, as pointed out by D. Low in his landmark publication, specialized upper-GI units with a specific and inherent interest in outcome research are in the best position to meet the future requirements of esophageal cancer surgery centralization [ 14 ].…”