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Textbook outcome as indicator of surgical quality in a single Western center: results from 300 consecutive gastrectomies

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Abstract

Textbook outcome (TO) has been proposed as a tool to evaluate surgical quality. Textbook oncological outcome (TOO) adds chemotherapeutic compliance to TO. This study was conducted to analyze the TO and TOO of patients with gastric adenocarcinoma who underwent surgery at our center. Data from a prospective database of patients operated on for gastric adenocarcinoma between September 2018 and September 2022 were analyzed. Postoperative management followed Enhanced Recovery After Surgery guidelines. The Dutch Upper Gastrointestinal Cancer Audit group defined TO as a multidimensional measure (10 items). TOO also considers guideline-accordant chemotherapeutic compliance. Three hundred patients underwent surgery during the study period (167 men, 133 women). One hundred seventy-six (58.7%) reached TO. Achieving TO was influenced by patients’ comorbidities, calculated via the Charlson Comorbidity Score (3 vs. 4; p = 0.002) and surgery type (subtotal gastrectomy; p < 0.001), but not by the American Society of Anesthesiologists (ASA) score (p = 0.057) or surgical approach (laparoscopic vs. open; p = 0.208). The analysis of TOO included 213 patients. Of these, 71 (33%) underwent complete adequate systemic treatment. Compared with the non-TOO group, patients who achieved TOO had a lower median age (64 vs. 73 years; p < 0.001) and lower ASA score (p < 0.001) and more frequently underwent preoperative chemotherapy (p < 0.001). Our results represent the experience of a single team at a high-volume Western institute. Patients’ comorbidities and surgery type influenced whether TO was achieved. Conversely, younger age, lower ASA score and preoperative chemotherapy were associated with TOO.

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Funding

The authors received no support from any organization for the submitted work.

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Authors and Affiliations

  1. Digestive Surgery, European Institute of Oncology, IRCCS, Milan, Italy

    Marco Realis Luc, Stefano de Pascale, Filippo Ascari, Alessandro Michele Bonomi, Emilio Bertani & Uberto Fumagalli Romario

  2. University of Milan, Milan, Italy

    Marco Realis Luc & Alessandro Michele Bonomi

  3. Division of Gastrointestinal and Neuroendocrine Tumors, European Institute of Oncology, IRCCS, Milan, Italy

    Chiara Alessandra Cella & Lorenzo Gervaso

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  1. Marco Realis Luc
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  2. Stefano de Pascale
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Contributions

Study conception and design were performed by SDP, UFR and MRL. Material preparation, data collection and analysis were performed by MRL, FA and SDP. The first draft of the manuscript was written by MRL and SDP and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Marco Realis Luc.

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The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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All procedures involving human participants were performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. All patients enrolled signed informed consent for the surgical intervention and for all procedures related to the disease treatment.

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Patients provided consent for data recording for research and use according to institutional policy.

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Realis Luc, M., de Pascale, S., Ascari, F. et al. Textbook outcome as indicator of surgical quality in a single Western center: results from 300 consecutive gastrectomies. Updates Surg (2023). https://doi.org/10.1007/s13304-023-01727-w

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