Background: The textbook outcome (TO) is an indicator to evaluate surgical quality based on clinical, pathological, and surgical outcomes.
Objective: To analyze the frequency, factors associated with achievement, and the prognostic impact of TO in gastric cancer treatment.
Methods: Retrospective analysis of patients with gastric cancer operated with curative intent from 2009 to 2022 in a reference Cancer Center.
Results: During the period, 681 patients were included and 444 (65.2%) achieved TO. Major surgical complications were the most common not-achieved outcome (16.4%) and intraoperative complications were the most achieved (96.2%). Most of the patients have failed in only 1 outcome (n = 105, 44.3%). Failure to achieve TO was associated with Charlson-Deyo comorbidity index ≥1 (46.4% vs 34.7%, p = 0.003), American Society of Anesthesiologists classification III/IV (40.1% vs 24.1%, p < 0.001), higher mean neutrophil-to-lymphocyte ratio (2.7 vs 3.3, p = 0.024), D1 lymphadenectomy (26.2% vs 15.8%, p = 0.001), and elective postoperative Intensive Care Unit admission (46.4% vs 38.5%, p = 0.046). Disease-free and overall survival (both p < 0.001) were higher in the TO group even after the exclusion of cases with surgical mortality (p = 0.013 and p = 0.024, respectively).
Conclusions: TO was achieved in most of the cases and its failure was associated with poor clinical performance and it impacts both early surgical results as well as long-term survival.
Keywords: gastric cancer; outcome assessment; quality of health care; surgical procedures; survival analyses.
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