Textbook outcome in ovarian cancer with peritoneal carcinomatosis: a systematic review

Textbook Outcome (TO) has emerged as a composite quality metric in oncologic surgery, but its role in ovarian cancer-related peritoneal carcinomatosis remains unclear. This systematic review aimed to evaluate the definitions, achievement rates, and clinical relevance of TO in patients undergoing cytoreductive surgery for ovarian cancer with peritoneal carcinomatosis.

A systematic literature search was conducted in PubMed, Embase, Scopus, and Web of Science following PRISMA 2020 guidelines. Studies evaluating composite outcomes or TO in ovarian cancer patients with peritoneal carcinomatosis were included. Data on study characteristics, TO definitions, achievement rates, and associations with oncologic outcomes were extracted. Methodological quality was assessed using the Newcastle-Ottawa Scale (NOS).

From 47 identified records, three observational studies met the inclusion criteria. Definitions of TO varied across studies but consistently included complete cytoreduction as a core component. TO achievement rates ranged from 20.5% to 55.9%. Two studies demonstrated a significant association between TO achievement and improved overall survival, while one population-based study highlighted substantial inter-hospital variability in TO rates. All included studies were rated as having good methodological quality according to the Newcastle-Ottawa Scale (NOS).

Despite heterogeneity in definitions, TO appears to be a promising composite quality indicator, although current evidence remains limited and should be interpreted with caution in ovarian cancer surgery with peritoneal carcinomatosis and is consistently associated with improved oncologic outcomes. These findings support the need for an internationally standardized definition of TO to facilitate benchmarking, quality improvement, and future prospective research in this complex clinical setting.