Union is strength: Textbook outcome with perioperative chemotherapy compliance decreases the risk of death in advanced gastric cancer patients

Sędłak, Katarzyna; Rawicz‐Pruszyński, Karol; Mlak, Radosław; Gęca, Katarzyna; Skórzewska, Magdalena; Pelc, Zuzanna; Małecka‐Massalska, Teresa; Polkowski, Wojciech

doi:10.1016/j.ejso.2021.08.005

Cited by 16 publications

(11 citation statements)

References 35 publications

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“…29 The proportion of patients completing the ideal hospitalization reported in previous studies on gastric cancer ranged from 22% to 51%, reaching in some Asian centres 72%. [18][19][20][21][30][31][32][33][34] Postoperative complications and the low number of evaluated lymph nodes were the most common limiting factors, but also those responsible for gradually increasing trends in TO. 18-20, 22, 31-35 Though TO seems to be a potentially useful tool for communicating and comparing outcomes for complex oncologic procedures, there are challenges with the optimum construction of its elements.…”

Section: Discussionmentioning

confidence: 99%

“…19 The criteria proposed by Busweiler et al were subsequently used for oesophago-gastric surgery in other studies. 11,[30][31][32][33] However, another de nitions of TO or textbook oncologic outcome (TOO) were published including four, 22,23 eight 18, 20 or nine 21 components. Moreover, the alterations included not only the number of individual indicators, but also their de nitions like the minimum number of lymph nodes (15 19 or 16 22 ), prolonged hospital stay (19 days, 23 21 days, 19 or 75 th percentile of the cohort 22 ), and postoperative mortality (30 days 19 or 90 days 20 ).…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of optimum classification measures used to define textbook outcome among patients undergoing curative-intent resection of gastric cancer

Bobrzyński

Sędłak

Rawicz‐Pruszyński

et al. 2023

Preprint

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Background: Textbook outcome (TO) is a composite measure reflecting various aspects of services provided to patients with solid malignancies. We sought to evaluate the importance of various TO components previously proposed for gastric cancer. Methods: Prospectively maintained electronic databases of 1,743 patients treated in two academic surgical centres were reviewed. Six candidate definitions of TO were evaluated based on their ability to accurately predict patients’ prognosis by Cox proportional hazards modelling. Results: TO definition combining 10 measures corresponding to complete tumour resection with an uneventful postoperative course showed the best goodness of fit by achieving the lowest values of Akaike (AIC) and Bayesian (BIC) information criteria and the best predictive performance based on the highest value of c-index. The overall median survival was significantly longer for patients with than without textbook outcome (69.0 vs 20.1 months, P<0.001). TO maintained its prognostic value in a multivariate model controlling for age, sex, comorbidities, treatment, and tumour related variables and was associated with a 39% lower risk of death (HR 0.61, 95%CI 0.51 – 0.73, P<0.001). Nine variables identified as predictors of TO were used to develop a nomogram showing very good correlation between the predicted and actual probability of achieving TO. The AUC of ROC obtained from the nomogram was 0.752 (95% CI 0.727 to 0.781). Conclusions: A uniform definition of textbook outcome provides clinically relevant prognostic information and could be used in quality improvement programs for gastric cancer patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Evaluation of optimum classification measures used to define textbook outcome among patients undergoing curative-intent resection of gastric cancer

Bobrzyński

Sędłak

Rawicz‐Pruszyński

et al. 2023

Preprint

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“…A definition established by DUCA consisting of 10 characteristics was used: (1) radical resection according to the surgeons' assessment at the end of the operation, (2) no intraoperative complications, (3) negative resection margins (R0), (4) at least 15 lymph nodes (LNs) retrieved and examined, (5) no severe postoperative complications, (6) no reinterventions, (7) no readmission to intensive care unit (ICU), (8) no prolonged hospital stay (21 days), (9) no postoperative mortality, and (10) no hospital readmission. 1 Postoperative complications, reinterventions, postoperative mortality, and readmissions were assessed within 30 postoperative days.…”

Section: Definition Of Textbook Outcomementioning

confidence: 99%

“…As shown in a recent single-institution study, thus defined textbook oncological outcome (TOO) decreases the risk of death in advanced patients with GC. 10 However, the sample size of patients with GC from Eastern Europe was relatively small.…”

mentioning

confidence: 99%

“…The addition of POC compliance to TO allows comprehensive quality assessment of multimodal treatment of patients with GC. As shown in a recent single-institution study, thus defined textbook oncological outcome (TOO) decreases the risk of death in advanced patients with GC 10 . However, the sample size of patients with GC from Eastern Europe was relatively small.…”

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confidence: 99%

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Textbook Oncological Outcome in European Gastrodata

et al. 2023

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Objective: To assess the rate of textbook outcome (TO) and textbook oncological outcome (TOO) in European population based on Gastrodata registry. Background: TO is a composite parameter assessing surgical quality and strongly correlates with improved overall survival. Following the standard of treatment for locally advanced gastric cancer (GC), TOO was proposed as a quality and optimal multimodal treatment parameter. Methods: TO was achieved when all the following criteria were met: no intraoperative complications, radical resection according to the surgeon, pR0 resection, retrieval of at least 15 lymph nodes, no severe postoperative complications, no reintervention, no admission to the intensive care unit, no prolonged length of stay, no postoperative mortality and no hospital readmission. TOO was defined as TO with addition of perioperative chemotherapy compliance. Results: From the 2558 patients, 1700 were included in the analysis. TO was achieved in 1164 (68.5%) patients. The use of neoadjuvant chemotherapy (OR=1.33, 95%CI: 1.04-1.70) and D2 or D2+ lymphadenectomy (OR=1.55, 95%CI: 1.15-2.10) had a positive impact on TO achievement. Older age (OR=0.73, 95%CI: 0.54-0.94), pT3/4 (OR=0.79, 95%CI: 0.63-0.99), ASA 3/4 (OR=0.68, 95%CI: 0.54-0.86) and total gastrectomy (OR=0.56, 95%CI: 0.45-0.70), had negative impact on TO achievement. TOO was achieved in 388 (22.8%) patients. Older age (OR=0.37, 95%CI: 0.27-0.53), pT3-pT4 (OR=0.52, 95%CI: 0.39-0.69) and ASA 3-4 (OR=0.58, 95%CI: 95%CI: 0.43-0.79) had negative impact on TOO achievement. Conclusion: Despite successively improved surgical outcomes, stage‐appropriate chemotherapy in adherence to the current guidelines for multimodal treatment of GC remains poor. Further implementation of oncologic quality metrics should include greater emphasis on perioperative chemotherapy and adequate lymphadenectomy.

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How to measure quality of surgery as a component of multimodality treatment of gastric cancer

Polkowski,

Gęca,

Skórzewska

2024

Annals of Gastroent Surgery

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Gastric cancer (GC) is one of the most frequent reasons for cancer‐related death worldwide. The multimodal therapeutic strategies are now pragmatically tailored to each patient, especially in advanced GC. A radical but safe gastrectomy remains the cornerstone of the GC treatment. Moreover, the quality‐of‐life (QoL) outcome measures are now routinely utilized in order to select optimal type of gastrectomy, as well as reconstruction method. Postoperative complications are frequent, and effective diagnosis and treatment of complications is crucial to lower the mortality rates. The postoperative complications prolong hospital stay and may result in poor QoL, thus eliminating the completion of perioperative adjuvant therapy. Therefore, avoiding morbidity is not only relevant for the immediate postoperative course, but can also affect long‐term oncological outcome. Measuring outcome enables surgeons to: monitor their own results; compare quality of treatment between centres; facilitate improvement both for surgery alone and combined treatment; select optimal procedure for an individual patient. Textbook oncological outcome is a composite quality measure representing the ideal hospitalization for gastrectomy, as well as stage‐appropriate (perioperative) adjuvant chemotherapy. Standardized system for recording complications and adherence to multimodality treatment guidelines are crucial for achieving the ultimate goal of surgical quality‐improvement that can benefit patients QoL and long‐term outcomes after fast and uneventful hospitalization for gastrectomy.

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Union is strength: Textbook outcome with perioperative chemotherapy compliance decreases the risk of death in advanced gastric cancer patients

Cited by 16 publications

References 35 publications

Evaluation of optimum classification measures used to define textbook outcome among patients undergoing curative-intent resection of gastric cancer

Evaluation of optimum classification measures used to define textbook outcome among patients undergoing curative-intent resection of gastric cancer

Textbook Oncological Outcome in European Gastrodata

How to measure quality of surgery as a component of multimodality treatment of gastric cancer

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