Textbook outcome and survival after gastric cancer resection with curative intent: A population-based analysis

Cero, Mariagiulia Dal; Román, Marta; Grande, Luís; Yárnoz, Concepción; Estremiana, Fernando; Gantxegi, Amaia; Codony, Clara; Gobbini, Yanina; Garsot, Elisenda; Momblán, Dulce; González-Duaigües, Marta; Luna, A. Bayés de; Pérez-Romero, Noelia; Aldeano, Aurora; Fernández, Sonia; Olona, Carles; Hermoso, Judit; Pulido, Laura; Sánchez-Cano, J.J.; Güell, Mercè; Salazar, David; Gimeno, M.A.F.; Pera, Manuel

doi:10.1016/j.ejso.2021.10.025

Cited by 19 publications

(33 citation statements)

References 37 publications

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“…[15][16][17] TO has also been investigated in few population-based cohort studies recruiting patients with gastric cancer. [18][19][20] The data obtained corroborated the anticipated variability in quality of care and identi ed the limiting factors for achieving TO. Moreover, they suggested signi cant correlation between accomplishing TO and superior long-term survival.…”

Section: Introductionmentioning

confidence: 53%

“…29 The proportion of patients completing the ideal hospitalization reported in previous studies on gastric cancer ranged from 22% to 51%, reaching in some Asian centres 72%. [18][19][20][21][30][31][32][33][34] Postoperative complications and the low number of evaluated lymph nodes were the most common limiting factors, but also those responsible for gradually increasing trends in TO. 18-20, 22, 31-35 Though TO seems to be a potentially useful tool for communicating and comparing outcomes for complex oncologic procedures, there are challenges with the optimum construction of its elements.…”

Section: Discussionmentioning

confidence: 99%

“…Essentially, all previous studies demonstrated impaired survival among patients with gastric cancer who failed to achieve TO. 18,20,22,23,30,31,33 A Netherland national cohort study of 2,769 patients included in the DUCA registry between 2011 and 2016 reported signi cantly reduced hazard ratio (HR) of death associated with TO (10 measures) for both overall survival (HR 0.62, 95% CI 0.54 to 0.71) and conditional survival (HR 0.69, 95% CI 0.60 to 0.79). 30 Another cohort study recorded data of 1,836 patients from the Population Registry of Esophageal and Stomach Tumours in Ontario (PRESTO) between 2004 and 2015.…”

Section: Discussionmentioning

confidence: 99%

“…18 In a Spanish population-based analysis, age >64 years, Charlson comorbidity index ≥3, neoadjuvant chemoradiotherapy, multivisceral resection, and surgery performed in a community hospital were associated with the lower odds of achieving TO. 20 Although data from these three population-based studies suggested the ability to predict TO using relatively simple criteria, no validated tools were available so far. Therefore, we developed a 9-item nomogram using two independent and heterogenous datasets.…”

Section: Discussionmentioning

confidence: 99%

“…One of them is harmonisation of the previously proposed de nitions showing marked variability across studies. [18][19][20][21][22][23] Therefore, the objective of the current study was to evaluate candidate components of TO and identify those most relevant for patients' prognosis. Subsequently, we developed and validated a nomogram predicting TO after curative-intent resection of gastric cancer.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of optimum classification measures used to define textbook outcome among patients undergoing curative-intent resection of gastric cancer

Bobrzyński

Sędłak

Rawicz‐Pruszyński

et al. 2023

Preprint

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Background: Textbook outcome (TO) is a composite measure reflecting various aspects of services provided to patients with solid malignancies. We sought to evaluate the importance of various TO components previously proposed for gastric cancer. Methods: Prospectively maintained electronic databases of 1,743 patients treated in two academic surgical centres were reviewed. Six candidate definitions of TO were evaluated based on their ability to accurately predict patients’ prognosis by Cox proportional hazards modelling. Results: TO definition combining 10 measures corresponding to complete tumour resection with an uneventful postoperative course showed the best goodness of fit by achieving the lowest values of Akaike (AIC) and Bayesian (BIC) information criteria and the best predictive performance based on the highest value of c-index. The overall median survival was significantly longer for patients with than without textbook outcome (69.0 vs 20.1 months, P<0.001). TO maintained its prognostic value in a multivariate model controlling for age, sex, comorbidities, treatment, and tumour related variables and was associated with a 39% lower risk of death (HR 0.61, 95%CI 0.51 – 0.73, P<0.001). Nine variables identified as predictors of TO were used to develop a nomogram showing very good correlation between the predicted and actual probability of achieving TO. The AUC of ROC obtained from the nomogram was 0.752 (95% CI 0.727 to 0.781). Conclusions: A uniform definition of textbook outcome provides clinically relevant prognostic information and could be used in quality improvement programs for gastric cancer patients.

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Section: Introductionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Evaluation of optimum classification measures used to define textbook outcome among patients undergoing curative-intent resection of gastric cancer

Bobrzyński

Sędłak

Rawicz‐Pruszyński

et al. 2023

Preprint

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How to measure quality of surgery as a component of multimodality treatment of gastric cancer

Polkowski,

Gęca,

Skórzewska

2024

Annals of Gastroent Surgery

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Gastric cancer (GC) is one of the most frequent reasons for cancer‐related death worldwide. The multimodal therapeutic strategies are now pragmatically tailored to each patient, especially in advanced GC. A radical but safe gastrectomy remains the cornerstone of the GC treatment. Moreover, the quality‐of‐life (QoL) outcome measures are now routinely utilized in order to select optimal type of gastrectomy, as well as reconstruction method. Postoperative complications are frequent, and effective diagnosis and treatment of complications is crucial to lower the mortality rates. The postoperative complications prolong hospital stay and may result in poor QoL, thus eliminating the completion of perioperative adjuvant therapy. Therefore, avoiding morbidity is not only relevant for the immediate postoperative course, but can also affect long‐term oncological outcome. Measuring outcome enables surgeons to: monitor their own results; compare quality of treatment between centres; facilitate improvement both for surgery alone and combined treatment; select optimal procedure for an individual patient. Textbook oncological outcome is a composite quality measure representing the ideal hospitalization for gastrectomy, as well as stage‐appropriate (perioperative) adjuvant chemotherapy. Standardized system for recording complications and adherence to multimodality treatment guidelines are crucial for achieving the ultimate goal of surgical quality‐improvement that can benefit patients QoL and long‐term outcomes after fast and uneventful hospitalization for gastrectomy.

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Textbook outcome for evaluating the surgical quality of gastrectomy

Ramos,

Gusmão,

Pereira

et al. 2024

Journal of Surgical Oncology

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BackgroundThe textbook outcome (TO) is an indicator to evaluate surgical quality based on clinical, pathological, and surgical outcomes.ObjectiveTo analyze the frequency, factors associated with achievement, and the prognostic impact of TO in gastric cancer treatment.MethodsRetrospective analysis of patients with gastric cancer operated with curative intent from 2009 to 2022 in a reference Cancer Center.ResultsDuring the period, 681 patients were included and 444 (65.2%) achieved TO. Major surgical complications were the most common not‐achieved outcome (16.4%) and intraoperative complications were the most achieved (96.2%). Most of the patients have failed in only 1 outcome (n = 105, 44.3%). Failure to achieve TO was associated with Charlson‐Deyo comorbidity index ≥1 (46.4% vs 34.7%, p = 0.003), American Society of Anesthesiologists classification III/IV (40.1% vs 24.1%, p < 0.001), higher mean neutrophil‐to‐lymphocyte ratio (2.7 vs 3.3, p = 0.024), D1 lymphadenectomy (26.2% vs 15.8%, p = 0.001), and elective postoperative Intensive Care Unit admission (46.4% vs 38.5%, p = 0.046). Disease‐free and overall survival (both p < 0.001) were higher in the TO group even after the exclusion of cases with surgical mortality (p = 0.013 and p = 0.024, respectively).ConclusionsTO was achieved in most of the cases and its failure was associated with poor clinical performance and it impacts both early surgical results as well as long‐term survival.

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Textbook outcome and survival after gastric cancer resection with curative intent: A population-based analysis

Cited by 19 publications

References 37 publications

Evaluation of optimum classification measures used to define textbook outcome among patients undergoing curative-intent resection of gastric cancer

Evaluation of optimum classification measures used to define textbook outcome among patients undergoing curative-intent resection of gastric cancer

How to measure quality of surgery as a component of multimodality treatment of gastric cancer

Textbook outcome for evaluating the surgical quality of gastrectomy

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