Textbook Outcome After Gastrectomy Is Associated With Improved Survival: An Observational Study

Curative treatment of gastric cancer requires surgery combined with perioperative chemotherapy. Textbook outcome (TO) and textbook oncological outcome (TOO) have gained increasing attention as composite measures representing an ideal surgical and oncological course. We aimed to evaluate the rates of TO and TOO after gastrectomy and their association with long-term outcomes.

A single-center retrospective observational study was conducted. TO was defined as achieving all of the following: macroscopic radical resection, R0 resection, removal of ≥15 lymph nodes, absence of severe complications (Clavien-Dindo grade >II), no intraoperative complications, hospital stay <21 days, no 30-day mortality, and no unplanned intensive care unit admission, reintervention, or readmission within 30 days after surgery. TOO was defined as TO plus adherence to guideline-compliant chemotherapy. Univariate analyses and multivariable logistic regression were used to identify predictors for TO and TOO. Associations between TO, TOO, and long-term outcomes were analyzed using Kaplan-Meier and Cox regression.

We included 141 patients. TO was achieved in 56.7% and TOO in 25.9% of patients. TO was significantly associated with improved overall survival (hazard ratio: 0.31, P < 0.001) and recurrence-free survival (hazard ratio: 0.31, P < 0.001). TOO was not significantly associated with improved survival outcomes. The most common reasons for failing to achieve TO were severe complications (24.8%), reintervention (22.0%), and readmission (17.7%).

This study found TO and TOO rates of 56.7% and 25.9%, suggesting quality of care on an international level. TO was significantly associated with long-term survival, supporting its future use as an important quality metric.