Defining a textbook outcome for the resection of colorectal liver metastases

Abstract

Introduction Textbook outcomes (TBO) are composite measures of care which may be superior in assessing quality compared to traditional methods. We aim to define TBO which are specific to surgical resection of colorectal liver metastases, and investigate their impact on survival. Methods Single center analysis of all liver resections performed at our center from 2009 to 2020. A Cox model was used to identify perioperative outcomes which impacted on overall survival. These were retained with important postoperative outcomes to form a “TBO.” The impact of a TBO on overall survival was investigated using Kaplan−Meier curve analysis. Results TBO was achieved in 72.2% (197/273) of resections. Major morbidity (Clavien−Dindo ≥3) at 19.4% was the major limiting factor in not achieving a TBO. TBO was associated with improved 3‐year (77% vs. 55%), 5‐year (60.7% vs. 42.5%), and median (93 vs. 44 months) overall survival (log‐rank test, p = 0.006). Multivariable analysis revealed age >65 years, American Society of Anaesthesiologists Grade III–IV, and resection of >2 segments as factors predictive of not achieving a TBO. Conclusion TBO is a useful composite measure in surgery for colorectal liver metastases. It can highlight areas which may be targeted for quality improvement and be useful as a tool to examine variation between centers. Achieving a TBO is associated with a significant improvement in survival.

Textbook outcomes for liver resection: can a medium sized centre have acceptable outcomes?

“…[1][2][3] TO has recently been used to evaluate the post-operative success in liver surgery. [4][5][6][7] Rates of successful TO for liver surgery vary widely in the literature. The underlying pathology alters successful TO rates, from as low as 50% for biliary tree malignancies to 80% for colorectal cancer liver metastasis (CRCLM).…”

“…The underlying pathology alters successful TO rates, from as low as 50% for biliary tree malignancies to 80% for colorectal cancer liver metastasis (CRCLM). [4][5][6][7][8] There is also significant variation in rates of TO across different centres, with dedicated high volume cancer centres accomplishing better TO despite taking on more complex patients. 8,9 Achieving TO is associated with improved overall survival after liver resection.…”

“…Frameworks of TO have been developed for oesophagogastric, colon, bariatric and pancreatic surgery 1–3 . TO has recently been used to evaluate the post‐operative success in liver surgery 4–7 . Rates of successful TO for liver surgery vary widely in the literature.…”

“…Rates of successful TO for liver surgery vary widely in the literature. The underlying pathology alters successful TO rates, from as low as 50% for biliary tree malignancies to 80% for colorectal cancer liver metastasis (CRCLM) 4–8 . There is also significant variation in rates of TO across different centres, with dedicated high volume cancer centres accomplishing better TO despite taking on more complex patients 8,9 …”

Textbook Oncological Outcome in European Gastrodata

“…1 Apart from being a useful tool in clinical practice for several malignancies, including gastrointestinal cancers, TO is associated with better overall survival. 2,3 In patients with gastric cancer (GC), TO was initially proposed by Dutch Upper Gastrointestinal Cancer Audit (DUCA), and defined as a collective of several intra and postoperative parameters. DUCA, Population Registry of Esophageal and Stomach Tumors in Ontario, and recently, the European Registration of Cancer Care (Spanish EURECCA Registry) established TO as a strong prognostic factor in patients with GC.…”