Assessment of modified textbook outcomes following gastrectomy based on survival benefits: a multicenter...

Textbook outcome (TO) is an increasingly utilized metric for evaluating perioperative treatment quality. However, a standardized and universally accepted definition of TO in gastrectomy has not yet been established. This multicenter study aimed to evaluate the incidence of a modified definition of TO (mTO) and its association with long-term oncologic survival following gastrectomy.

Data from all consecutive patients undergoing curative-intent resection for gastric cancer were analyzed from institutional databases of seven high-volume centers in China between 7 January 2010, and 30 September 2019. The achievement rates of TO and mTO were measured. mTO was defined as achieving all of the following: pR0 resection, retrieval of at least 15 lymph nodes, absence of severe postoperative complications (Clavien-Dindo grade ≥IIIa) within 90 days, length of hospital stay below the 75th percentile, no 90-day mortality, and no 90-day readmission. The primary outcomes were the associations between mTO and 5-year overall survival (OS) and disease-free survival (DFS). The secondary outcome was to determine the rate of mTO and identify independent factors associated with its achievement.

Among 2608 eligible patients, the rates of mTO and TO were 62.4% (1628 patients) and 72.0% (1877 patients), respectively. Achieving mTO was independently associated with reduced hazards of death in Cox regression analysis for 5-year OS and DFS (HR 0.565 [95% CI: 0.504-0.633] and HR 0.561 [95% CI: 0.502-0.628], respectively). Similarly, achieving TO was independently associated with reduced hazards of death for 5-year OS and DFS (HR 0.737 [95% CI: 0.653-0.831] and HR 0.735 [95% CI: 0.65-0.827], respectively). Subgroup analyses demonstrated that mTO was consistently associated with a greater reduction in death hazards compared to TO for both OS and DFS.

mTO serves as a more comprehensive and beneficial indicator for assessing perioperative quality, providing superior survival benefits compared to TO.