'Textbook Outcome' quality measure predicts long-term survival after gastric resection

Last Updated: 2020-04-07

By Reuters Staff

NEW YORK (Reuters Health) - Achieving Textbook Outcome (TO), a composite quality measure, is associated with improved long-term survival following surgery in patients with gastric cancer, according to findings from the Population Registry of Esophageal and Stomach Tumors of Ontario (PRESTO).

TO includes intent of surgery, resection-margin status, adequate lymph node sampling, intraoperative and postoperative complications, reinterventions, ICU admissions, length of stay and mortality.

Dr. Natalie G. Coburn of Sunnybrook Health Sciences Center in Toronto, Canada, and colleagues reviewed the association between TO and survival after gastric-cancer surgery in 1,836 adults who underwent gastrectomy for non-metastatic gastric adenocarcinoma.

For the purposes of this study, achieving TO required meeting all of these criteria: negative resection margins, more than 15 lymph nodes sampled, no severe complications, no reinterventions, no unplanned ICU admission, length of stay 21 days or less, no readmission to hospital within 30 days after discharge, and no mortality in the 30 days after surgery.

Twenty-two percent of the patients achieved TO, the researchers report in the Annals of Surgery. The two quality metrics least likely to be achieved were adequate lymph node sampling (achieved in 54% of cases) and the absence of severe complications (achieved in 67%).

Three-year survival was significantly higher in TO patients (75%) than in non-TO patients (56%). After adjustment for other factors, TO was associated with a significant 41% decrease in the relative risk of death.

In multivariable analyses, negative margins, adequate lymph node sampling, no unplanned ICU admission, and no 30-day readmission were independently associated with survival.

"TO is a new concept in gastric cancer surgery and represents a composite of surgical quality metrics, which is strongly associated with improved long-term survival," the authors conclude. "It is measurable, reproducible, and merits further focus in surgical quality improvement efforts in gastric cancer internationally."

Dr. Coburn did not respond to a request for comments.

SOURCE: https://bit.ly/2J97FZH Annals of Surgery, online March 6, 2020.