Textbook outcome was associated with better survival in oral cancer surgery in southern Taiwan

Abstract

ObjectiveTo explore the impact of textbook outcome (TO) on long‐term survival in oral cancer surgery.Subjects and MethodsIn total, 386 patients with tumor resection, neck dissection (ND), and reconstruction between 2011 and 2020 were included. TO was defined as negative margin; adequate ND; no 3‐day emergency room revisit; no 30‐day readmission; and length of stay ≤22 days. Multivariate Cox regression was used to evaluate the impact of TO and 5‐year overall survival (OS).ResultsThe TO rate was 35%. Younger age, subsite in buccal area, Charlson Comorbidity Index Score of 0, higher body mass index, higher hemoglobin, higher albumin, and unilateral ND were associated with TO. 5‐year OS was 70.5% in overall TO patients and 49.0% in non‐TO patients (HR, 0.47; 95% CI, 0.31–0.70; p < 0.001). Non‐TO was associated with an increased mortality rate (aHR, 1.73; 95% CI, 1.14–2.63) after adjusting other factors and the result remained robust with inverse probability of treatment weighting analysis. The impact of TO on OS was more significant in age <60, advanced stage, and diagnosis year before 2018.ConclusionNot achieving TO in oral cancer surgery was associated with worse long‐term outcome. TO could be used as a proxy for surgical quality improvement.

Comment on: Textbook outcome was associated with better survival in oral cancer surgery in southern Taiwan

“…There has been limited research in assessing the role of TO in head and neck cancers so far. In a recently published study from Taiwan (Chiou & Lee, 2023), the authors reported that the TO rate was 35% and the patients who achieved TO had a higher 5-year overall survival rate (70.5%) compared to non-TO patients (49.0%).…”