Textbook outcome in esophagogastric oncological surgery and long-term survival - A systematic review and meta-analysis.
Jeppe S Gregersen, Trygve U Solstad, Michael P Achiam et al.
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In 30 seconds
This systematic review and meta-analysis examined whether achieving Textbook Outcome (TO), a composite measure of surgical quality, was associated with long-term survival after esophageal or gastric cancer surgery. It included 38 studies and 160,596 patients; TO achievement ranged from 21.8% to 84.2% (mean 49.4%, 95% CI 43.8-55.1%). In the 27 studies pooled for overall survival, TO achievement was associated with lower mortality (pooled HR 0.62, 95% CI 0.58-0.67, p < 0.0001). Associations were consistent across esophageal, gastric, and mixed cohorts.
Key findings
- Across 27 studies, TO achievement was associated with lower mortality (pooled HR 0.62, 95% CI 0.58-0.67, p < 0.0001).
- Mean TO achievement was 49.4% (95% CI 43.8-55.1%), with rates ranging from 21.8% to 84.2%.
- Seven studies found lower mortality among patients achieving TOO (HR 0.72, 95% CI 0.66-0.78, p < 0.0001).
- Weighted survival differences were 17%, 6%, and 23.5% at 2-, 3-, and 5-year follow-up, respectively.
Why it matters
The findings link a composite measure of perioperative performance with long-term survival across esophageal and gastric cancer surgery. TO may therefore help describe surgical quality in a way that captures more than a single complication or process measure. However, the review identifies standardization of TO definitions as important for meaningful comparisons and quality improvement.
What to keep in mind
The pooled evidence is based on studies reporting associations; it does not establish that achieving TO causes improved survival. TO definitions require standardization, as noted by the authors.