Predictors of textbook outcome following oesophagogastric cancer surgery.
Ganesh K VelayudhamAlexander DermanisSivesh Kathir KamarajahEwen Alexander GriffithsPublished in: Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus (2024)
Textbook outcome (TO) is a composite measure representing an ideal perioperative course, which has been utilized to assess the quality of care in oesophagogastric cancer (OGC) surgery. We aim to determine TO rates among OGC patients in a UK tertiary center, investigate predictors of TO attainment, and evaluate the relationship between TO and survival. A retrospective analysis of a prospectively collected departmental database between 2006 and 2021 was conducted. Patients that underwent radical OGC surgery with curative intent were included. TO attainment required margin-negative resection, adequate lymphadenectomy, uncomplicated postoperative course, and no hospital readmission. Predictors of TO were investigated using multivariable logistic regression. The association between TO and survival was evaluated using Kaplan-Meier analysis and Cox regression modeling. In sum, 667 esophageal cancer and 312 gastric cancer patients were included. TO was achieved in 35.1% of esophagectomy patients and 51.3% of gastrectomy patients. Several factors were independently associated with a low likelihood of TO attainment: T3 stage (odds ratio (OR): 0.41, 95% confidence interval (CI) [0.22-0.79], p = 0.008) and T4 stage (OR:0.26, 95% CI [0.08-0.72], p = 0.013) in the esophagectomy cohort and high BMI (OR:0.93, 95% CI [0.88-0.98], p = 0.011) in the gastrectomy cohort. TO attainment was associated with greater overall survival and recurrence-free survival in esophagectomy and gastrectomy cohorts. TO is a relevant quality metric that can be utilized to compare surgical performance between centers and investigate patients at risk of TO failure. Enhancement of preoperative care measures can improve TO rates and, subsequently, long-term survival.
Keyphrases
- end stage renal disease
- ejection fraction
- chronic kidney disease
- newly diagnosed
- healthcare
- free survival
- peritoneal dialysis
- minimally invasive
- prognostic factors
- palliative care
- squamous cell carcinoma
- quality improvement
- radiation therapy
- patient reported outcomes
- body mass index
- coronary artery disease
- mass spectrometry
- physical activity
- cross sectional
- coronary artery bypass
- chronic pain
- atrial fibrillation
- acute coronary syndrome
- pain management
- high resolution
- weight loss
- affordable care act