The Clinical Impact of Textbook Outcome in Patients With Stage 1 Gastric Cancer Who Received Laparoscopy-assisted...

We evaluated the clinical impact of textbook outcome (TO) in patients with stage I gastric cancer (GC) who underwent minimally invasive surgery (MIS). Moreover, we identified the risk factors associated with achieving TO in these patients.

Patients were selected from the database of the Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital between 2005 and 2025. Our definition of TO comprised 10 items: complete (potentially curative) resection, R0 resection, retrieval of more than 16 lymph nodes, no intraoperative complications, no severe postoperative complications (Clavien-Dindo grade III or higher), no reintervention after surgery, no unplanned ICU/HCU admission, no readmission within 30 days after discharge, no prolonged hospital stay (defined as more than 21 days after surgery), and no mortality within 30 days after surgery.

We analyzed 889 patients who underwent MIS and were pathologically diagnosed with stage I GC. Among them, 621 patients (69.8%) achieved TO, whereas 268 patients (30.2%) did not. The most frequent reason for failure to achieve TO was prolonged hospital stay (>21 days after surgery) (17.5%), followed by postoperative surgical complications (15.4%). In the multivariate analysis, age [odds ratio (OR)=1.619), BMI (OR=1.849), and type of gastrectomy (OR=1.674) were identified as independent risk factors for failure to achieve TO. The 5-year overall survival (OS) rate was 97.5% in patients who achieved TO and 94.7% in those who did not, showing a significant difference between the two groups (p=0.041).

The TO achievement rate was approximately 70%, and failure to achieve TO was associated with age, preoperative BMI, and type of gastrectomy. Achievement of TO was associated not only with favorable short-term outcomes but also with improved long-term oncological outcomes.