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Updated: Jun 14, 2025

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Textbook Outcome in Colorectal Surgery for Cancer: An Italian Version.

Silvia Sofia1, Maurizio Degiuli1, Gabriele Anania2

  • 1Department of Oncology, Division of Surgical Oncology and Digestive Surgery, San Luigi University Hospital, University of Turin, 10043 Turin, Italy.

Journal of Clinical Medicine
|August 29, 2024
PubMed
Summary

A standardized definition for textbook outcomes (TO) in colorectal cancer surgery was established using the Delphi method. This ensures consistent quality assessment and improved patient care across Italian surgical units.

Keywords:
colorectal cancercolorectal surgerycomposite measurepatient outcomequality of caretextbook outcome

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Area of Science:

  • Oncology
  • Surgical Quality Improvement
  • Gastroenterology

Background:

  • The textbook outcome (TO) is a composite tool for standardizing surgical quality.
  • Defining TO in colorectal cancer surgery is crucial due to cancer prevalence.
  • Current definitions of TO lack uniformity.

Purpose of the Study:

  • To establish a consensus-based Italian definition of textbook outcome (TO) for colorectal cancer surgery.
  • To improve the uniformity and quality of care in colorectal cancer treatment.

Main Methods:

  • A modified Delphi process involving two rounds of online questionnaires.
  • An expert panel of 28 Italian colorectal oncological surgeons participated.
  • Consensus was achieved on items with at least 75% agreement.

Main Results:

  • The Italian TO for colorectal cancer includes 90-day survival, negative margins, ≥12 lymph nodes, minimally invasive surgery, planned ostomy, Clavien-Dindo < 3b complications, ≥10 ERAS items, no readmission, appropriate CHT/RT, complete colonoscopy, and Tumor Board Evaluation.
  • Twenty-eight experts reached consensus on the defined criteria.

Conclusions:

  • The proposed Italian textbook outcome serves as a quality instrument for comprehensive colorectal cancer patient care.
  • This expert-defined TO provides a standardized framework from diagnosis through treatment.