Textbook outcomes after colon and rectal cancer surgery: results of a multicentre national study

Textbook outcomes (TO) are a composite measure of ideal postoperative outcomes. Using a multicentre national study, we aimed to describe the rate and associated factors with TO for colorectal cancer (CRC) surgery. Stage I-III colorectal cancer who underwent curative surgery were retrospectively identified from 80 centres from 2018 to 2021 using a large national study dataset. Recurrent, synchronous, and metastatic cancer, urgent surgery, and SARS-CoV-2 infection were excluded. TO include radical resection (R0, CRM-), > 12 lymph nodes yield, adequate length of stay (LOS ≤ 75th°), no 30-day mortality, and no Clavien-Dindo ≥ III morbidity. 13842 patients were included: 9869 with colon (TO: 67%) and 3973 with rectal cancer (TO: 53%). TO were not achieved the most by inadequate lymph node yield, Clavien-Dindo classification ≥ III, and prolonged postoperative LOS. In colon cancer surgery the use of laparoscopy was the strongest predictor (OR 2.21), along with being female (OR 1.25), cT1-T2 and cT3-T4a (vs. T0-Tis) stages (OR 1.66 and OR 1.86), and cN2 (vs. N0 or N1) stage (OR 1.23) for achieving TO after colon cancer surgery. Age ≥ 65years, pulmonary comorbidities, alcoholic hepatopathy, previous CRC, anticoagulants, left-sided cancer, ASA score > 2, centre volume, additional surgery, conversion, intraoperative surgical complications, ileostomy, and mild postoperative complications only (Clavien-Dindo ≤ II) were negatively associated. In rectal cancer, female sex (OR 1.26) and high rectal cancer (OR 1.84) were positively associated, while age ≥ 75years, previous CRC, T4b stage, intraoperative surgical complications, and mild postoperative complications were negatively associated. This study reports rates and factors independently associated with TO for colon and rectal cancer using a large multicentre cohort.