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Updated: Jul 1, 2026
06:46
Caudal-to-cranial Approach in Laparoscopic Right Hemicolectomy with Complete Mesocolon Excision and D3 Lymph Node Dissection
Published on: January 9, 2026
Redefining textbook outcome in contemporary colon surgery.
Matthew Paul Zeller1, Rachel Ma2, Joseph Wetherell1
1Department of Surgery, Sinai Hospital of Baltimore, Baltimore, MD, United States.
Summary
A redefined Textbook Outcome (TO) for colon surgery, using a 3-day length of stay (LOS), shows significant improvement over time. Minimally invasive surgery, especially robotic, strongly predicts achieving this enhanced surgical quality measure.
Area of Science:
- Surgical Quality Measurement
- Colorectal Surgery Outcomes
- Health Services Research
Background:
- Existing Textbook Outcome (TO) definitions for colon surgery are outdated, not reflecting modern minimally invasive techniques or recovery pathways.
- A need exists to redefine TO using contemporary, data-driven standards to accurately assess surgical quality in elective colectomy.
Purpose of the Study:
- To redefine Textbook Outcome (TO) for elective colectomy using a contemporary length-of-stay (LOS) standard.
- To evaluate the incidence, temporal trends, and predictors of achieving this redefined TO.
Main Methods:
- Retrospective cohort study utilizing the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2012-2022).
- Included adult patients undergoing elective colectomy.
- Defined TO as LOS ≤ 3 days plus absence of 30-day morbidity, mortality, readmission, or reoperation; LOS threshold determined by cohort analysis.
- Analyzed trends and predictors using multivariable logistic regression.
Main Results:
- Among 139,064 patients, 44.5% achieved the redefined TO.
- TO rates significantly improved from 29.3% in 2012 to 50.2% in 2022, plateauing post-2019.
- Minimally invasive surgery, particularly robotic (OR 8.30) and laparoscopic (OR 4.21), strongly predicted TO.
- Factors associated with reduced TO included advanced age (>80), frailty (FI ≥ 3), non-home discharge, bleeding indication, and ostomy creation.
Conclusions:
- A contemporary TO definition (LOS ≤ 3 days) provides a rigorous benchmark for perioperative recovery in elective colectomy.
- TO achievement has substantially improved, driven by minimally invasive approaches, especially robotic surgery.
- This patient-centered definition aids in evaluating and contextualizing surgical quality in modern colon surgery.
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