Textbook Outcomes After Esophagectomy with Gastric Conduit for Cancer: A 2016-2021 National Surgical Quality...

Textbook outcome (TO) is a composite measure designed to assess the overall short-term outcome of an operation. TO after esophagectomy with gastric conduit using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database has not yet been defined.

Records in the NSQIP Esophagectomy Procedure-Targeted database from 2016 to 2021 were analyzed. Patients who underwent elective esophagectomies with gastric conduit for resectable esophageal cancer were included. TO was defined as the absence of anastomotic leak, major complications, positive surgical margins, reintervention ≤30 d postsurgery, prolonged hospital stay (> 21 d), postoperative mortality ≤ 30 d after surgery, and readmission ≤ 30 d after discharge.

Of the 6813 patients in the 2016-2021 NSQIP database who underwent esophagectomy, 3733 met study criteria. A total of 2520 (68%) patients achieved TO. The presence of a major complication most frequently prevented the achievement of TO (19%, 692/3733), while the presence of postoperative mortality ≤ 30 d after surgery least frequently prevented achievement of TO (2.3%). The most common complications were organ/space Surgical Site Infection (10%, 372/3733) and unplanned intubation (10%, 366/3733). Of the 493 patients who failed to achieve TO due to one parameter, positive margins (4.7%, 175/3733) and major complications (3.2%, 120/3733) most frequently prevented the achievement of TO. In a multivariable analysis, node stage of 2 or 3 in the TNM staging system, chronic obstructive pulmonary disease, American Society of Anesthesiologists classification of 4, underweight body mass index, Asian race, prolonged operation time, increased preoperative white blood cell, and older age had statistically significant association with failure to achieve TO.

In an analysis of the NSQIP database, 68% of cases resulted in TO. Several factors were associated with failure to achieve TO. Further investigations are needed to test if modifying variables like preoperative weight can lead to improved outcomes.