Textbook Outcomes and Survival in Gastric Cancer Surgery: Results of a French-Speaking Multicenter Study

TO is a composite parameter used to assess surgical care quality. In oncologic gastric surgery, TO includes the following criteria: complete potentially curative resection during operation, no intraoperative complications, resection of at least 15 lymph nodes, absence of severe postoperative complications, no prolonged hospital stay, no reoperation, no postoperative mortality, and achievement of R0 resection. The objective of the study is to investigate the achievement of textbook outcome (TO) and its association with overall survival in patients treated for gastric cancer and to identify factors that contribute to the failure to meet TO criteria.

This multicenter French-speaking center retrospective study, based on data from the French Association of Surgery database, analyzed 2131 patients treated for gastric cancer between 2007 and 2017. Patients who met the TO criteria were compared with those who did not.

Among the 958 eligible patients, TO was achieved in 398 (41.5%) patients. TO achievement was significantly associated with improved overall survival (p < 0.01) and disease-free survival (p < 0.01). In the univariate analysis, factors associated with failure to achieve TO included age, body mass index, tumor location and stage, neoadjuvant treatment, and type of gastrectomy. In the multivariate analysis, only BMI > 30 and tumor of the lesser curvature treatment remained significantly associated with failure to achieve TO.

TO is associated with improved overall and disease-free survival in patients undergoing surgery for gastric cancer. BMI < 30 and tumor of the lesser curvature were independently associated with a higher rate of TO.