International journal of surgery (London, England) · 2025
Assessment of modified textbook outcomes following gastrectomy based on survival benefits: a multicenter observational study.
СтатьяМногоцентровое исследованиеНаблюдательное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Lin Xia, Yu Wenbin, Zhang Wei, Huang He, Jing Changqing, Qian Feng, Shi Yan, Tan Chenjun, Li Zhengyan, Yuan Zhen, You Jun, Wei Bo, Zhao Yongliang
Аннотация
BACKGROUND: Textbook outcome (TO) is an increasingly utilized metric for evaluating perioperative treatment quality. However, a standardized and universally accepted definition of TO in gastrectomy has not yet been established. This multicenter study aimed to evaluate the incidence of a modified definition of TO (mTO) and its association with long-term oncologic survival following gastrectomy.
METHODS: Data from all consecutive patients undergoing curative-intent resection for gastric cancer were analyzed from institutional databases of seven high-volume centers in China between 7 January 2010, and 30 September 2019. The achievement rates of TO and mTO were measured. mTO was defined as achieving all of the following: pR0 resection, retrieval of at least 15 lymph nodes, absence of severe postoperative complications (Clavien-Dindo grade ≥IIIa) within 90 days, length of hospital stay below the 75th percentile, no 90-day mortality, and no 90-day readmission. The primary outcomes were the associations between mTO and 5-year overall survival (OS) and disease-free survival (DFS). The secondary outcome was to determine the rate of mTO and identify independent factors associated with its achievement.
RESULTS: Among 2608 eligible patients, the rates of mTO and TO were 62.4% (1628 patients) and 72.0% (1877 patients), respectively. Achieving mTO was independently associated with reduced hazards of death in Cox regression analysis for 5-year OS and DFS (HR 0.565 [95% CI: 0.504-0.633] and HR 0.561 [95% CI: 0.502-0.628], respectively). Similarly, achieving TO was independently associated with reduced hazards of death for 5-year OS and DFS (HR 0.737 [95% CI: 0.653-0.831] and HR 0.735 [95% CI: 0.65-0.827], respectively). Subgroup analyses demonstrated that mTO was consistently associated with a greater reduction in death hazards compared to TO for both OS and DFS.
CONCLUSION: mTO serves as a more comprehensive and beneficial indicator for assessing perioperative quality, providing superior survival benefits compared to TO.
METHODS: Data from all consecutive patients undergoing curative-intent resection for gastric cancer were analyzed from institutional databases of seven high-volume centers in China between 7 January 2010, and 30 September 2019. The achievement rates of TO and mTO were measured. mTO was defined as achieving all of the following: pR0 resection, retrieval of at least 15 lymph nodes, absence of severe postoperative complications (Clavien-Dindo grade ≥IIIa) within 90 days, length of hospital stay below the 75th percentile, no 90-day mortality, and no 90-day readmission. The primary outcomes were the associations between mTO and 5-year overall survival (OS) and disease-free survival (DFS). The secondary outcome was to determine the rate of mTO and identify independent factors associated with its achievement.
RESULTS: Among 2608 eligible patients, the rates of mTO and TO were 62.4% (1628 patients) and 72.0% (1877 patients), respectively. Achieving mTO was independently associated with reduced hazards of death in Cox regression analysis for 5-year OS and DFS (HR 0.565 [95% CI: 0.504-0.633] and HR 0.561 [95% CI: 0.502-0.628], respectively). Similarly, achieving TO was independently associated with reduced hazards of death for 5-year OS and DFS (HR 0.737 [95% CI: 0.653-0.831] and HR 0.735 [95% CI: 0.65-0.827], respectively). Subgroup analyses demonstrated that mTO was consistently associated with a greater reduction in death hazards compared to TO for both OS and DFS.
CONCLUSION: mTO serves as a more comprehensive and beneficial indicator for assessing perioperative quality, providing superior survival benefits compared to TO.