Achieving a Textbook Outcome in Colon Cancer Surgery Is Associated with Improved Long-Term Survival

Abstract

Background: Colon cancer surgery is a complex clinical pathway and traditional quality metrics may exhibit significant variability between hospitals and healthcare providers. The Textbook Outcome (TO) is a composite quality marker capturing the fraction of patients, in whom all desired short-term outcomes of care are realised. The aim of the present study was to assess the TO in a series of non-metastatic colon cancer patients treated with curative intent, with emphasis on long-term survival. Methods: Stage I–III colon cancer patients, who underwent curative colectomy following the Complete Mesocolic Excision principles, were retrospectively identified from the institutional database. TO was defined as (i) hospital survival, (ii) radical resection, (iii) no major complications, (iv) no reintervention, (v) no unplanned stoma and (vi) no prolonged hospital stay or readmission. Results: In total, 128 patients (male 61%, female 39%, mean age 70.7 ± 11.4 years) were included in the final analysis. Overall, 60.2% achieved a TO. The highest rates were observed for “hospital survival” and “no unplanned stoma” (96.9% and 97.7%), while the lowest rates were for “no major complications” and “no prolonged hospital stay” (69.5% and 75%). Older age, left-sided resections and pT4 tumours were factors limiting the chances of a TO. The 5-year overall and 5-year cancer-specific survival were significantly better in the TO versus non-TO subgroup (81% vs. 59%, p = 0.009, and 86% vs. 65%, p = 0.02, respectively). Conclusions: Outcomes in colon cancer surgery may be affected by patient-, doctor- and hospital-related factors. TO represents those patients who achieve the optimal perioperative results, and is furthermore associated with improved long-term cancer survival.

Impact of safety‐net hospital burden on achievement of textbook oncologic outcomes following resection in for stage I–IV colorectal cancer

“…For colorectal cancers, previous authors have commented on the utility of TOO as a composite metric associated with increased survival when achieved, while few prior studies have examined TOO in patients undergoing surgical resection for colorectal liver metastasis. 4,7,27 To our knowledge, however, no study has sought to understand how safety-net hospital burden affects the achievement of TOO and subsequent long-term survival. In addition, our study establishes that the TOO paradigm can be applied to colorectal cancer with metastasis to the liver.…”

“…While clinicians will aim for perfection in their work, quality metrics met by fewer than half of patients warrant reevaluation of patient, tumor, facility, and provider‐specific factors. For colorectal cancers, previous authors have commented on the utility of TOO as a composite metric associated with increased survival when achieved, while few prior studies have examined TOO in patients undergoing surgical resection for colorectal liver metastasis 4,7,27 . To our knowledge, however, no study has sought to understand how safety‐net hospital burden affects the achievement of TOO and subsequent long‐term survival.…”

“…4 Across a variety of cancers, including colon and rectal cancers, achievement of TOO has been shown to be associated with improved long-term survival, highlighting its clinical utility as a metric for quality of surgical cancer care. [5][6][7] Colorectal cancer remains a prominent global health issue, with approximately 1.9 million new diagnoses and over 900,000 deaths per year. 8,9 For patients with localized colorectal cancer, surgical resection remains the mainstay of curative treatment and is supplemented by stage-appropriate adjuvant chemotherapy to address minimal residual and occult metastases.…”

“…This method was developed in the routine surgical treatment of colon cancer and includes receipt of all of the following: negative margin resection, adequate nodal yield, no prolonged hospitalization, no 30‐day readmission or death, and timely adjuvant therapy 4 . Across a variety of cancers, including colon and rectal cancers, achievement of TOO has been shown to be associated with improved long‐term survival, highlighting its clinical utility as a metric for quality of surgical cancer care 5–7 …”