International Expert Consensus on Defining Textbook Oncologic Outcomes in Cytoreductive Surgery and Hyperthermic...

Area of Science:

• Surgical Oncology
• Oncologic Outcomes
• Peritoneal Surface Malignancies

Background:

• Textbook Oncologic Outcome (TOO) is a composite metric linked to better survival in oncologic procedures.
• No standardized definition for TOO exists for cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).

Purpose of the Study:

• To establish an international consensus definition for TOO in CRS and HIPEC for peritoneal surface malignancies.
• To evaluate the impact of achieving consensus-defined TOO on patient survival outcomes.

Main Methods:

• A Delphi methodology was used, involving 54 senior surgeons in the field of peritoneal surface malignancies.
• Two online meetings and questionnaires defined TOO parameters across operative, short-term, and long-term postoperative outcomes.
• Consensus required a 75% agreement rate; clinical data from 251 patients undergoing CRS and HIPEC for colorectal peritoneal metastasis were analyzed.

Main Results:

• Expert consensus defined TOO parameters including absence of unplanned reoperations/readmissions, severe complications (Clavien-Dindo ≥III), 90-day mortality, timely chemotherapy, and complete cytoreduction (CC0).
• Of 251 patients, 151 (60%) met the consensus TOO criteria.
• Patients achieving TOO demonstrated significantly improved overall survival (67.5 vs. 44.6 months) and disease-free survival (12 vs. 9 months).

Conclusions:

• The consensus definition of TOO in CRS and HIPEC for colorectal peritoneal metastasis is associated with improved patient survival.
• Establishing a standardized TOO metric can guide clinical practice and improve outcomes in patients with peritoneal surface malignancies.