Textbook outcome and survival after gastric cancer resection with curative intent: A population-based analysis

Background: The concept of textbook outcome (TO) has been proposed for analyzing quality of surgical care. This study assessed the incidence of TO among patients undergoing curative gastric cancer resection, predictors for TO achievement, and the association of TO with survival. Method: All patients with gastric and gastroesophageal junction cancers undergoing curative gastrec-tomy between January 2014-December 2017 were identified from a population-based database (Spanish EURECCA Registry). TO included: macroscopically complete resection at the time of operation, R0 resection, >= 15 lymph nodes removed and examined, no serious postoperative complications (Clavien-Dindo >= II), no re-intervention, hospital stay <= 14 days, no 30-day readmissions and no 90-day mortality. Logistic regression was used to assess the adjusted achievement of TO. Cox survival regression was used to compare conditional adjusted survival across groups. Results: In total, 1293 patients were included, and TO was achieved in 541 patients (41.1%). Among the criteria, macroscopically complete resection had the highest compliance (96.5%) while no serious complications had the lowest compliance (63.7%). Age (OR 0.53 for the 65-74 years and OR 0.34 for the >= 75 years age group), Charlson comorbidity index >= 3 (OR 0.53, 95%CI 0.34-0.82), neoadjuvant che-moradiotherapy (OR 0.24, 95%CI 0.08-0.70), multivisceral resection (OR 0.55, 95%CI 0.33-0.91), and surgery performed in a community hospital (OR 0.65, CI95% 0.46-0.91) were independently associated with not achieving TO. TO was independently associated with conditional survival (HR 0.67, 95%CI 0.55-0.83). Conclusion: TO was achieved in 41.1% of patients who underwent gastric cancer resection with curative intent and was associated with longer survival. (C) 2021 Elsevier Ltd, BASO - The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

Automated summary

This study assessed the incidence of textbook outcome (TO) among patients undergoing curative gastric cancer resection and found an achievement rate of 41.1%. Age, comorbidity index, neoadjuvant treatment, multivisceral resection, and hospital type were associated with the achievement of TO. TO was associated with patient survival.