Textbook outcome of gastric cancer surgery and lymph node evaluation as its parameter to improve long-term survival

The textbook outcome (TO) is a short-term outcome that integrates postoperative outcomes to evaluate the quality of surgery. In gastric cancer surgery, most TO data have been reported from Western countries. We aimed to analyze TO in Korea, where gastric cancer is prevalent and evaluate its effect on long-term survival. Based on the parameters defined by the Dutch Upper Gastrointestinal Cancer Audit (DUCA), we evaluated the TO, 5-year overall survival (OS), and independent prognostic factors stratified according to the TNM stage. The TO was achieved in 74.6% patients. Significant differences were observed in the 5-year OS rate between groups achieving TO and non-TO groups regardless of stage. The TO and ≥ 30 retrieved lymph nodes was an independent prognostic factor in patients with stage II/III tumors. The median number of retrieved lymph nodes required for D2 dissection increased depending on the tumor stage, from 38 in stage IA, whereas in distal and total gastrectomy D2 lymph node dissection was 44 and 55 in stages II and III, respectively. Therefore, evaluation of more than 30 lymph nodes should be considered to achieve optimal radical gastric cancer surgery.