The Association of Textbook Outcome and Long-Term Survival After Esophagectomy for Esophageal Cancer

Kalff, Marianne C.; Vesseur, Isolde; Eshuis, Wietse J.; Heineman, David J.; Daams, Freek; Peet, Donald L. van der; Henegouwen, Mark I. van Berge; Gisbertz, Suzanne S.

doi:10.1016/j.athoracsur.2020.09.035

Cited by 35 publications

(15 citation statements)

References 24 publications

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“…Previous studies have used TO to compare differences in medical quality between different hospitals (13,23). Some recent studies have reported that the realization of TO is related to the prognosis of esophageal cancer, and that TO-compliant patients exhibit an increased OS rate and reduced risk of death (19,20). However, in the era of minimally invasive treatment, the prognosis of TO in patients with ESCC who undergo MIE remains unclear.…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies have suggested that MIE itself optimizes the quality of surgery and increases the possibility of achieving TO. When MIE was included as one of the parameters of TO, the combined TO resulted in significant improvement in the OS rate of patients with cancer (19,20). Therefore, it is important to investigate the prognostic value of TO in patients with ESCC who are treated with MIE.…”

Section: Introductionmentioning

confidence: 99%

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Textbook outcome after minimally invasive esophagectomy is an important prognostic indicator for predicting long-term oncological outcomes with locally advanced esophageal squamous cell carcinoma

Xu¹,

Lin²,

Chen³

et al. 2022

Ann Transl Med

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Background: The textbook outcome (TO) emerges as a novel prognostic factor in surgical oncology.The present study aimed to evaluate the effect of TO on the risk of death and recurrence in patients with esophageal squamous cell carcinoma (ESCC) after minimally invasive esophagectomy (MIE). Methods:The study involved retrospective analysis of 528 patients with ESCC who were subjected to MIE from January 2011 to December 2017. TO included 8 parameters: complete resection; microscopically tumor-negative resection margins (R0); ≥15 lymph nodes removed and examined; no serious postoperative complications; no postoperative intervention; no re-admission to the intensive care unit (ICU); hospital stay ≤21 days; and no readmission ≤30 days. The Cox and logistic regression model were used to analyze the prognostic factors of survival and risk factors for TO.Results: Among the 528 patients with ESCC who were subjected to MIE, 53.2% reached TO. In the case of patients with locally advanced ESCC, 5-year overall survival (OS) was 51.1% (41.2-61.2%) for the TO group but 33.7% (23.7-43.7%) for the non-TO group (HR =0.644, 95% CI: 0.449-0.924, P=0.015).Similarly, 5-year disease-free survival (DFS) was 47.6% (38.0-57.2%) for the TO group but 29.1% (20.1-38.1%) for the non-TO group (HR =0.671, 95% CI: 0.479-0.940, P=0.018). In addition, 5-year recurrencefree survival (RFS) was 62.9% (53.7-72.1%) for the TO group but 39.8% (29.4-50.2%) for the non-TO group (HR =0.606, 95% CI: 0.407-0.902, P=0.012). Multivariate logistic regression analysis further showed that age, American Society of Anesthesiology (ASA) score, intraoperative blood loss, and smoking status acted as independent risk factors for TO. The results of the multivariate analysis assisted in the establishment of a nomogram for the prediction of TO occurrence. This nomogram exhibited satisfactory consistency and prediction ability [area under the receiving operator characteristic (AUROC) =0.717].

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Textbook outcome after minimally invasive esophagectomy is an important prognostic indicator for predicting long-term oncological outcomes with locally advanced esophageal squamous cell carcinoma

Xu¹,

Lin²,

Chen³

et al. 2022

Ann Transl Med

View full text Add to dashboard Cite

show abstract

“…For example, more squamous cell carcinomas and higher ASA scores are associated with a lower textbook outcome rate. 8 These case-mix factors, among others, can also reflect the expertise of a hospital and should be considered when interpreting and comparing textbook outcome rates.…”

Section: Discussionmentioning

confidence: 99%

“…Adjacent to its use for quality assurance purposes in the obligatory Dutch audit, textbook outcome for gastro-esophageal cancer surgery is used in multiple research projects, 6–8 not limited to Dutch origin. 9 , 10 Previous studies showed the correlation of achieved textbook outcome with increased survival, 6 , 8 the increase in textbook outcome rate during the implementation of minimally invasive surgery, 7 and its relation with case volume. 9 Although textbook outcome is being increasingly recognized as a valuable quality indicator, controversy concerning some of the items used in this composite measure exists; some items show overlapping definitions and others may need to be redefined.…”

Section: Introductionmentioning

confidence: 99%

Textbook outcome for esophageal cancer surgery: an international consensus-based update of a quality measure

Kalff

Henegouwen

Gisbertz

2021

Diseases of the Esophagus

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Summary Textbook outcome for esophageal cancer surgery is a composite quality measure including 10 short-term surgical outcomes reflecting an uneventful perioperative course. Achieved textbook outcome is associated with improved long-term survival. This study aimed to update the original textbook outcome based on international consensus. Forty-five international expert esophageal cancer surgeons received a personal invitation to evaluate the 10 items in the original textbook outcome for esophageal cancer surgery and to rate 18 additional items divided over seven subcategories for their importance in the updated textbook outcome. Items were included in the updated textbook outcome if ≥80% of the respondents agreed on inclusion. In case multiple items within one subcategory reached ≥80% agreement, only the most inclusive item with the highest agreement rate was included. With a response rate of 80%, 36 expert esophageal cancer surgeons, from 34 hospitals, 16 countries, and 4 continents responded to this international survey. Based on the inclusion criteria, the updated quality indicator ‘textbook outcome for esophageal cancer surgery’ should consist of: tumor-negative resection margins, ≥20 lymph nodes retrieved and examined, no intraoperative complication, no complications Clavien–Dindo ≥III, no ICU/MCU readmission, no readmission related to the surgical procedure, no anastomotic leakage, no hospital stay ≥14 days, and no in-hospital mortality. This study resulted in an international consensus-based update of a quality measure, textbook outcome for esophageal cancer surgery. This updated textbook outcome should be implemented in quality assurance programs for centers performing esophageal cancer surgery, and could standardize quality measures used internationally.

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“…For example, textbook outcome (a composite measure describing the event of a radical resection, without intraoperative or postoperative complications, adequate lymph node yield, short hospital stay, no reinterventions, no postoperative mortality and no hospital or ICU readmission) can be interpreted as a completely successful and uneventful operation [ 86 ]. Besides, textbook outcome has shown to be related to improved survival rates [ 88 ]. Another example is failure to cure (a composite measure describing an R1 or R2 resection, nonresctional/’open–close’ surgery and/or early postoperative mortality), which can be interpreted as an unsuccessful procedure [ 82 , 85 ].…”

Section: Postoperative Outcomementioning

confidence: 99%

Surgical Therapy of Esophageal Adenocarcinoma—Current Standards and Future Perspectives

Schröder

Gisbertz

Voeten

et al. 2021

Cancers

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Transthoracic esophagectomy is currently the predominant curative treatment option for resectable esophageal adenocarcinoma. The majority of carcinomas present as locally advanced tumors requiring multimodal strategies with either neoadjuvant chemoradiotherapy or perioperative chemotherapy alone. Minimally invasive, including robotic, techniques are increasingly applied with a broad spectrum of technical variations existing for the oncological resection as well as gastric reconstruction. At the present, intrathoracic esophagogastrostomy is the preferred technique of reconstruction (Ivor Lewis esophagectomy). With standardized surgical procedures, a complete resection of the primary tumor can be achieved in almost 95% of patients. Even in expert centers, postoperative morbidity remains high, with an overall complication rate of 50–60%, whereas 30- and 90-day mortality are reported to be <2% and <6%, respectively. Due to the complexity of transthoracic esophagetomy and its associated morbidity, esophageal surgery is recommended to be performed in specialized centers with an appropriate caseload yet to be defined. In order to reduce postoperative morbidity, the selection of patients, preoperative rehabilitation and postoperative fast-track concepts are feasible strategies of perioperative management. Future directives aim to further centralize esophageal services, to individualize surgical treatment for high-risk patients and to implement intraoperative imaging modalities modifying the oncological extent of resection and facilitating surgical reconstruction.

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The Association of Textbook Outcome and Long-Term Survival After Esophagectomy for Esophageal Cancer

Abstract: Dr van Berge Henegouwen discloses a financial relationship with Stryker, Olympus, Johnson & Johnson, Medtronic, and Mylan; Dr Gisbertz with Olympus and Medtronic.

Cited by 35 publications

References 24 publications

Textbook outcome after minimally invasive esophagectomy is an important prognostic indicator for predicting long-term oncological outcomes with locally advanced esophageal squamous cell carcinoma

Textbook outcome after minimally invasive esophagectomy is an important prognostic indicator for predicting long-term oncological outcomes with locally advanced esophageal squamous cell carcinoma

Textbook outcome for esophageal cancer surgery: an international consensus-based update of a quality measure

Surgical Therapy of Esophageal Adenocarcinoma—Current Standards and Future Perspectives

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