Textbook oncologic outcome is associated with increased overall survival after esophagectomy

Assessment of quality in oncologic operations traditionally involves use of discrete metrics reported individually. Such metrics have limited value to payers and patients making broad comparisons of clinical programs. We define a composite textbook oncologic outcome for esophagectomy.

The National Cancer Database was queried to identify patients presenting with clinically resectable esophageal cancer between 2004 and 2015. Textbook oncologic outcome was defined as stage-appropriate use of neoadjuvant chemoradiation followed by margin negative esophagectomy with formal lymph node assessment and having no prolonged hospitalization, readmission, or 30-day mortality.

Fourteen thousand nine hundred and sixty-nine patients underwent esophagectomy. Of those, 5,561 (37.2%) had textbook oncologic outcome. The overall survival of patients having textbook oncologic outcome was significantly longer than those who did not (52.1 (95% confidence interval [49.0-58.8]) vs 29.1 months (95% confidence interval [29.1-32.3]). On multivariable modeling adjusted for age, comorbid conditions, demographics, treatment characteristics, and esophagectomy volume, volume (odds ratio 1.38, 95% confidence interval [1.16-1.65]) and minimally invasive approach were independently associated with textbook oncologic outcome (odds ratio 1.15, 95% confidence interval [1.02-1.30]), and textbook oncologic outcome was independently associated with improved overall survival (hazard ratio 0.74, 95% confidence interval [0.68-0.80]).

Textbook oncologic outcome is achieved in a minority of patients undergoing esophagectomy. Textbook oncologic outcome is independently associated with improved overall survival.