Association between textbook outcome and long-term survival among patients undergoing curative-intent resection of gastric cancer

Xia Lin; Chenjun Tan; Weigao Wu; Chenglong Liang; Feng Qian; Yan Shi; Yongliang Zhao

doi:10.1016/j.surg.2024.07.022

Association between textbook outcome and long-term survival among patients undergoing curative-intent resection of gastric cancer

Surgery. 2024 Aug 23:S0039-6060(24)00541-5. doi: 10.1016/j.surg.2024.07.022. Online ahead of print.

Authors

Xia Lin¹, Chenjun Tan², Weigao Wu², Chenglong Liang², Feng Qian², Yan Shi³, Yongliang Zhao⁴

Affiliations

¹ Department of General Surgery, Southwest Hospital of the Third Military Medical University, Chongqing, China; Department of Gastroenterology and Gastric Surgery, Three Gorges Hospital, Chongqing University, Chongqing, China.
² Department of General Surgery, Southwest Hospital of the Third Military Medical University, Chongqing, China.
³ Department of General Surgery, Southwest Hospital of the Third Military Medical University, Chongqing, China. Electronic address: shiyandoctor@sina.com.
⁴ Department of General Surgery, Southwest Hospital of the Third Military Medical University, Chongqing, China. Electronic address: yongliang1666@126.com.

PMID: 39181724
DOI: 10.1016/j.surg.2024.07.022

Abstract

Background: A single metric does not sufficiently capture the multidimensional and complex perioperative nature of treatment for patients with gastric cancer. There is a newly developed composite indicator, called textbook outcome, that reflects the "ideal" surgical outcome. However, limited evidence exists for the long-term prognosis of textbook outcome in patients with gastric cancer. Thus, this study was aimed at assessing the association between textbook outcome and long-term oncologic prognosis after gastrectomy.

Methods: In total, 2,658 consecutive patients who underwent gastrectomy between January 2004 and December 2017 were included. The primary endpoint was 5-year conditional survival (if the patient survived the first 30 days after surgery). Textbook outcome was defined as retrieved ≥15 lymph nodes, pR0 resection, complete-potentially curative resection during operation, hospitalization ≤21 days, no reinterventions, no severe postoperative complications, no hospital readmission ≤30 days after discharge, no unplanned intensive care unit treatment, and no 30-day postoperative mortality. Multivariable analysis was performed to evaluate the adjusted predictors of textbook outcome. A Cox regression analysis was used to analyze the relationship between achieving textbook outcome parameters and long-term oncologic prognosis.

Results: A total of 1,770 (66.6%) of the 2,658 patients achieved all textbook outcome metrics in this study. The textbook outcome group displayed a greater 5-year conditional overall survival than the nontextbook outcome group (64.7% vs 40.2%, P < .001). The 5-year conditional disease-free survival of the patients with textbook outcomes was strongly superior to that of the patients without textbook outcomes (63.1% vs 37.6%, P < .001). Textbook outcome was independently associated with longer 5-year conditional overall survival and disease-free survival (hazard ratio 0.494 [0.439-0.557] and hazard ratio 0.487 [0.433-0.547], respectively).

Conclusions: Attaining textbook outcome is strongly related to an improved long-term oncologic prognosis for patients with gastric cancer, underscoring the need for continued efforts to enhance surgical care quality.