Assessment of textbook outcome after lobectomy for early‐stage non‐small cell lung cancer in a Korean institution: A retrospective study

Abstract

Background Textbook outcome (TO) has been introduced as a novel composite measure for lung cancer surgery. We investigated TO after lobectomy for early‐stage non‐small cell lung cancer (NSCLC) in a Korean tertiary hospital and its prognostic implications for overall survival and recurrence. Methods Between January 2012 and December 2017, 418 consecutive patients who underwent lobectomy for clinical stages I and II NSCLC were identified and retrospectively reviewed. TO was defined as complete resection (negative resection margins and sufficient lymph node dissection), no 30‐day or in‐hospital mortality, no reintervention within 30 days, no readmission to the intensive care unit, no prolonged hospital stay (<14 days), no hospital readmission within 30 days, and no major complications. Propensity score matching analysis was performed to investigate the association between TO, medical costs, and long‐term outcomes. Results Of 418 patients, 277 (66.3%) achieved TO. The most common events leading to TO failure were prolonged air leakage (n = 54, 12.9%) and prolonged hospital stay (n = 53, 12.7%). Male sex (odds ratio [OR] = 2.148, p = 0.036) and low diffusing capacity for carbon monoxide (OR = 0.986, p = 0.047) were significant risk factors for failed TO in multivariate analysis. In matched cohorts, achieving TO was associated with lower medical costs and better overall survival but not cancer recurrence. Conclusions TO is associated with low medical cost and favorable overall survival; thus, surgical teams and hospitals should make efforts to improve the quality of care and achieve TO.

The impact of social determinants of health on textbook oncological outcomes and overall survival in locally advanced non–small cell lung cancer

“…TOO parameters differ based on the databases used in each study, which may not be captured by NCDB. 1 , 2 , 3 In our study, we defined lymph node evaluation as ≥5 rather than 10. 32 In addition, NCDB does not have granular data to explain the reason for delayed chemotherapy initiation.…”

“…TOO is used for colorectal, upper gastrointestinal, and aneurysm surgery and has recently been explored in non–small cell lung cancer (NSCLC). 1 , 2 , 3 In NSCLC, TOO mandates surgical R0 resection, adequate lymph node resection for pathologic examination, timely receipt adjuvant therapy when indicated, and no prolonged length of hospital stay, 30-day mortality, reintervention, unplanned readmission, or major complications. Previous studies of stage I NSCLC demonstrated that TOO metrics were associated with superior overall survival (OS).…”