Textbook outcome for evaluating the surgical quality of gastrectomy

The textbook outcome (TO) is an indicator to evaluate surgical quality based on clinical, pathological, and surgical outcomes.

To analyze the frequency, factors associated with achievement, and the prognostic impact of TO in gastric cancer treatment.

Retrospective analysis of patients with gastric cancer operated with curative intent from 2009 to 2022 in a reference Cancer Center.

During the period, 681 patients were included and 444 (65.2%) achieved TO. Major surgical complications were the most common not-achieved outcome (16.4%) and intraoperative complications were the most achieved (96.2%). Most of the patients have failed in only 1 outcome (n = 105, 44.3%). Failure to achieve TO was associated with Charlson-Deyo comorbidity index ≥1 (46.4% vs 34.7%, p = 0.003), American Society of Anesthesiologists classification III/IV (40.1% vs 24.1%, p < 0.001), higher mean neutrophil-to-lymphocyte ratio (2.7 vs 3.3, p = 0.024), D1 lymphadenectomy (26.2% vs 15.8%, p = 0.001), and elective postoperative Intensive Care Unit admission (46.4% vs 38.5%, p = 0.046). Disease-free and overall survival (both p < 0.001) were higher in the TO group even after the exclusion of cases with surgical mortality (p = 0.013 and p = 0.024, respectively).

TO was achieved in most of the cases and its failure was associated with poor clinical performance and it impacts both early surgical results as well as long-term survival.