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Luna A, Pérez-Romero N, Rebasa P, Adell M, Montmany S, Cidoncha A, Herrero C, Mora L. Robotic gastrectomy: can it be implemented without compromising the results? J Robot Surg 2025; 19:118. [PMID: 40100455 DOI: 10.1007/s11701-024-02206-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2024] [Accepted: 12/20/2024] [Indexed: 03/20/2025]
Affiliation(s)
- Alexis Luna
- Parc Tauli University Hospital, Sabadell, Spain.
| | | | | | | | | | | | | | - Laura Mora
- Parc Tauli University Hospital, Sabadell, Spain
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De Martino J, Challine A, Collard MK, Lefevre JH, Parc Y, Paye F, Voron T. Optimizing surgical outcomes in gastric cancer: a comparison of laparoscopic and open total gastrectomy. J Gastrointest Surg 2025; 29:101955. [PMID: 39788450 DOI: 10.1016/j.gassur.2025.101955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2024] [Revised: 12/16/2024] [Accepted: 01/05/2025] [Indexed: 01/12/2025]
Abstract
BACKGROUND The efficacy of the laparoscopic approach for total gastrectomy (TG) in Western countries remains under discussion. Recently, textbook outcome (TO) has gained recognition as a comprehensive measure of quality of care in upper gastrointestinal surgery. Although predictive factors for TO after TG are well documented, the influence of the surgical approach requires further analysis. This study aimed to compare the TO completion rate after TG for gastric cancer between the open (OTG) and laparoscopic TG (LTG) approaches. METHODS TO was defined by 10 criteria: (1) absence of intraoperative complications, (2) macroscopically complete resection, (3) R0 margin, (4) retrieval of ≥15 lymph nodes, (5) absence of postoperative complications with Clavien-Dindo grade ≥ 2, (6) no surgical reintervention within 30 days, (7) no unplanned intensive care unit admission within 30 days, (8) no mortality within 30 days, (9) length of stay ≤ 21 days, and (10) no readmission within 30 days. Propensity score matching was used to adjust for potential selection bias. Predictive factors associated with TO were identified through univariate and multivariate analyses. RESULTS Among the 188 patients, 34 underwent LTG. TO was achieved in 46.8% of cases, with no significant difference between OTG and LTG (45.5% vs 52.9%; P =.43). After propensity score matching, similar outcomes were observed (44.1% vs 52.9%; P =.47). However, LTG was associated with fewer postoperative complications of Clavien-Dindo grade ≥ 2 (P =.049), particularly pulmonary complications (P =.041). CONCLUSION This study confirms the feasibility and safety of LTG for cancer. The laparoscopic approach yields a TO completion rate comparable with that of the open approach while reducing postoperative complications.
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Affiliation(s)
- Julien De Martino
- Department of Digestive Surgery, Saint-Antoine Hospital, AP-HP, Paris, France
| | - Alexandre Challine
- Department of General and Digestive Surgery, Saint-Antoine Hospital, AP-HP, Sorbonne University, Paris, France
| | - Maxime K Collard
- Department of General and Digestive Surgery, Saint-Antoine Hospital, AP-HP, Sorbonne University, Paris, France
| | - Jeremie H Lefevre
- Department of General and Digestive Surgery, Saint-Antoine Hospital, AP-HP, Sorbonne University, Paris, France
| | - Yann Parc
- Department of General and Digestive Surgery, Saint-Antoine Hospital, AP-HP, Sorbonne University, Paris, France
| | - François Paye
- Department of General and Digestive Surgery, Saint-Antoine Hospital, AP-HP, Sorbonne University, Paris, France
| | - Thibault Voron
- Department of General and Digestive Surgery, Saint-Antoine Hospital, AP-HP, Sorbonne University, Paris, France.
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Yu J, Wang Y, Liu L, Xiao Y, Yu G. Assessment of textbook oncologic outcome after neoadjuvant chemotherapy and interval debulking surgery for advanced ovarian cancer. J Obstet Gynaecol Res 2025; 51:e16218. [PMID: 39853684 DOI: 10.1111/jog.16218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2024] [Accepted: 01/10/2025] [Indexed: 01/26/2025]
Abstract
AIM To examine the prognostic impact of textbook oncologic outcome (TOO) in patients with advanced ovarian cancer undergoing primary chemotherapy, along with identifying the risk factors for TOO failure. METHODS Patients who underwent neoadjuvant chemotherapy followed by interval debulking surgery for advanced ovarian cancer at a tertiary center between 2014 and 2019 were retrospectively reviewed. TOO was defined as complete cytoreduction, no severe complications, no prolonged hospital stay, no readmission, no delayed initiation of adjuvant chemotherapy, and no 90-day mortality. The associations between TOO and clinical characteristics (survival) were examined using logistic and Cox regression analyses. RESULTS Among 165 patients, 65 (39.4%) achieved TOO. The most common reason for TOO failure was incomplete cytoreduction (n = 46, 27.9%). Older age (p = 0.049) and visceral obesity (p = 0.030) were independently associated with TOO failure. Patients who achieved TOO had significantly prolonged overall survival (OS; median: 52 vs. 31 months, p = 0.010) and progression-free survival (PFS; median: not reached vs. 19 months, p = 0.006) compared to those who did not achieve TOO. Multivariate analysis revealed that TOO achievement was an independent protective factor for OS (hazard ratio [HR] 0.591, 95% confidence interval [CI] 0.387-0.905, p = 0.015) and PFS (HR 0.626, 95% CI 0.410-0.956, p = 0.030). CONCLUSIONS TOO is an effective predictor of favorable outcomes in patients with advanced ovarian cancer undergoing interval debulking surgery. Factors such as older age and visceral obesity may hinder the achievement of TOO.
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Affiliation(s)
- Jiayin Yu
- Medicine College, Jiangsu University, Zhenjiang, China
| | - Yiyang Wang
- Medicine College, Jiangsu University, Zhenjiang, China
| | - Liqun Liu
- Medicine College, Jiangsu University, Zhenjiang, China
| | - Yaolong Xiao
- Medicine College, Jiangsu University, Zhenjiang, China
| | - Gang Yu
- Department of Gynaecology, Yixing People's Hospital, Yixing, China
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Zhong Q, Zheng ZF, Wu D, Shang-Guan ZX, Liu ZY, Jiang YM, Lin JX, Wang JB, Chen QY, Xie JW, Lin W, Zheng CH, Huang CM, Li P. Textbook oncological outcome of locally advanced gastric cancer patients with preoperative sarcopenia: a multicenter clinical study. Surg Endosc 2025; 39:356-367. [PMID: 39548007 DOI: 10.1007/s00464-024-11397-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Accepted: 10/29/2024] [Indexed: 11/17/2024]
Abstract
BACKGROUND The impact of postoperative sarcopenia on the Textbook Oncological Outcome (TOO) in locally advanced gastric cancer (LAGC) remains uncertain. This study investigates the relationship between sarcopenia and TOO, explores its long-term prognostic value, and develops a prognostic model incorporating sarcopenia and TOO for survival prediction. METHODS We performed a retrospective analysis of clinical and pathological data from patients with LAGC who underwent radical surgery at two Chinese tertiary referral hospitals. Sarcopenia was defined as an SMI < 36.4 cm2/m2 in males and < 28.4 cm2/m2 in females. TOO was defined as the addition of perioperative chemotherapy to the textbook outcomes (TO). A nomogram was developed to predict postoperative overall survival (OS) and recurrence-free survival (RFS) in LAGC patients. RESULTS The study included 972 patients with LAGC. The overall TOO achievement rate was 67.1%. The TOO achievement rate was significantly higher in patients non-sarcopenia compared to those with sarcopenia (68.9% vs. 61.1%, P = 0.031). Logistic regression revealed that age ≥ 65, high ASA score, and sarcopenia were independent risk factors for TOO failure. Cox regression analysis identified TOO, sarcopenia, tumor size, differentiation, vascular invasion, pT stage, and pN stage as independent predictors of OS and RFS. Nomogram models based on sarcopenia and TOO accurately predicted the 3-year and 5-year OS and RFS. CONCLUSION Preoperative sarcopenia was an independent predictor of TOO implementation. A prognostic prediction model that integrates preoperative sarcopenia and TOO, which outperforms the current staging system, can aid clinicians in effectively assessing the prognosis of patients with LAGC.
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Affiliation(s)
- Qing Zhong
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Zi-Fang Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Department of General Surgery, Affiliated Hospital of Putian University, Putian, China
| | - Dong Wu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Zhi-Xin Shang-Guan
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Zhi-Yu Liu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Yi-Ming Jiang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Jia-Bin Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Wei Lin
- Department of General Surgery, Affiliated Hospital of Putian University, Putian, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian, China.
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian, China.
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.
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Lin X, Tan C, Wu W, Liang C, Qian F, Shi Y, Zhao Y. Association between textbook outcome and long-term survival among patients undergoing curative-intent resection of gastric cancer. Surgery 2024; 176:1402-1411. [PMID: 39181724 DOI: 10.1016/j.surg.2024.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 06/25/2024] [Accepted: 07/16/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND A single metric does not sufficiently capture the multidimensional and complex perioperative nature of treatment for patients with gastric cancer. There is a newly developed composite indicator, called textbook outcome, that reflects the "ideal" surgical outcome. However, limited evidence exists for the long-term prognosis of textbook outcome in patients with gastric cancer. Thus, this study was aimed at assessing the association between textbook outcome and long-term oncologic prognosis after gastrectomy. METHODS In total, 2,658 consecutive patients who underwent gastrectomy between January 2004 and December 2017 were included. The primary endpoint was 5-year conditional survival (if the patient survived the first 30 days after surgery). Textbook outcome was defined as retrieved ≥15 lymph nodes, pR0 resection, complete-potentially curative resection during operation, hospitalization ≤21 days, no reinterventions, no severe postoperative complications, no hospital readmission ≤30 days after discharge, no unplanned intensive care unit treatment, and no 30-day postoperative mortality. Multivariable analysis was performed to evaluate the adjusted predictors of textbook outcome. A Cox regression analysis was used to analyze the relationship between achieving textbook outcome parameters and long-term oncologic prognosis. RESULTS A total of 1,770 (66.6%) of the 2,658 patients achieved all textbook outcome metrics in this study. The textbook outcome group displayed a greater 5-year conditional overall survival than the nontextbook outcome group (64.7% vs 40.2%, P < .001). The 5-year conditional disease-free survival of the patients with textbook outcomes was strongly superior to that of the patients without textbook outcomes (63.1% vs 37.6%, P < .001). Textbook outcome was independently associated with longer 5-year conditional overall survival and disease-free survival (hazard ratio 0.494 [0.439-0.557] and hazard ratio 0.487 [0.433-0.547], respectively). CONCLUSIONS Attaining textbook outcome is strongly related to an improved long-term oncologic prognosis for patients with gastric cancer, underscoring the need for continued efforts to enhance surgical care quality.
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Affiliation(s)
- Xia Lin
- Department of General Surgery, Southwest Hospital of the Third Military Medical University, Chongqing, China; Department of Gastroenterology and Gastric Surgery, Three Gorges Hospital, Chongqing University, Chongqing, China
| | - Chenjun Tan
- Department of General Surgery, Southwest Hospital of the Third Military Medical University, Chongqing, China
| | - Weigao Wu
- Department of General Surgery, Southwest Hospital of the Third Military Medical University, Chongqing, China
| | - Chenglong Liang
- Department of General Surgery, Southwest Hospital of the Third Military Medical University, Chongqing, China
| | - Feng Qian
- Department of General Surgery, Southwest Hospital of the Third Military Medical University, Chongqing, China
| | - Yan Shi
- Department of General Surgery, Southwest Hospital of the Third Military Medical University, Chongqing, China.
| | - Yongliang Zhao
- Department of General Surgery, Southwest Hospital of the Third Military Medical University, Chongqing, China.
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Zhong Q, Zheng ZF, Wu D, Shang-Guan ZX, Liu ZY, Zheng LY, Lin JX, Chen QY, Wang JB, Xie JW, Lin M, Lin W, Zheng CH, Huang CM, Li P. Developing a modified textbook outcome for elderly patients with gastric cancer: a multi-center study. Surg Endosc 2024; 38:5869-5880. [PMID: 39164437 DOI: 10.1007/s00464-024-11116-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 07/23/2024] [Indexed: 08/22/2024]
Abstract
OBJECTIVE Textbook outcome (TO) is widely recognized as a comprehensive prognostic indication for patients with gastric cancer (GC). This study aims to develop a modified TO (mTO) for elderly patients with GC. METHODS Data from the elderly patients (aged ≥ 65 years) in two Chinese tertiary referral hospitals were analyzed. 1389 patients from Fujian Medical University Union Hospital were assigned as the training cohort and 185 patients from Affiliated Hospital of Putian University as the validation cohort. Nomogram was developed by the independent prognostic factors of Overall Survival (OS) based on Cox regression. RESULTS In the training cohort, laparoscopic surgery was significantly correlated with higher TO rate (P < 0.05). Cox regression analysis revealed that surgical approach was also an independent factor of OS (P < 0.001), distinct from the traditional TO. In light of these findings, TO parameters were enhanced by the inclusion of surgical approach, rendering a modified TO (mTO). Further analysis showed that mTO, tumor size, pTNM staging, and adjuvant chemotherapy were independent prognostic factors associated with OS (all P < 0.05). Additionally, the nomogram incorporating these four indicators accurately predicted 1-, 3-, and 5-year OS in the training cohort, with AUC values of 0.793, 0.814, and 0.807, respectively, and exhibited outstanding predictive performance within the validation cohort. CONCLUSION mTO holds a robust association with the prognosis of elderly patients with GC, meriting intensified attention in efforts aimed at enhancing surgical quality. Furthermore, the predictive model incorporating mTO demonstrates excellent predictive performance for elderly patients with GC.
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Affiliation(s)
- Qing Zhong
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Zi-Fang Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
- Department of General Surgery, Affiliated Hospital of Putian University, Putian, China
| | - Dong Wu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Zhi-Xin Shang-Guan
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Zhi-Yu Liu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Lin-Yong Zheng
- Department of Bioinformatics, Fujian Medical University, Fuzhou, China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Jia-Bin Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Mi Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Wei Lin
- Department of General Surgery, Affiliated Hospital of Putian University, Putian, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
- Department of General Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
- Department of General Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.
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Polkowski WP, Gęca K, Skórzewska M. How to measure quality of surgery as a component of multimodality treatment of gastric cancer. Ann Gastroenterol Surg 2024; 8:740-749. [PMID: 39229566 PMCID: PMC11368491 DOI: 10.1002/ags3.12833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 05/06/2024] [Accepted: 05/20/2024] [Indexed: 09/05/2024] Open
Abstract
Gastric cancer (GC) is one of the most frequent reasons for cancer-related death worldwide. The multimodal therapeutic strategies are now pragmatically tailored to each patient, especially in advanced GC. A radical but safe gastrectomy remains the cornerstone of the GC treatment. Moreover, the quality-of-life (QoL) outcome measures are now routinely utilized in order to select optimal type of gastrectomy, as well as reconstruction method. Postoperative complications are frequent, and effective diagnosis and treatment of complications is crucial to lower the mortality rates. The postoperative complications prolong hospital stay and may result in poor QoL, thus eliminating the completion of perioperative adjuvant therapy. Therefore, avoiding morbidity is not only relevant for the immediate postoperative course, but can also affect long-term oncological outcome. Measuring outcome enables surgeons to: monitor their own results; compare quality of treatment between centres; facilitate improvement both for surgery alone and combined treatment; select optimal procedure for an individual patient. Textbook oncological outcome is a composite quality measure representing the ideal hospitalization for gastrectomy, as well as stage-appropriate (perioperative) adjuvant chemotherapy. Standardized system for recording complications and adherence to multimodality treatment guidelines are crucial for achieving the ultimate goal of surgical quality-improvement that can benefit patients QoL and long-term outcomes after fast and uneventful hospitalization for gastrectomy.
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Affiliation(s)
- Wojciech P. Polkowski
- Department of Surgical Oncology of the Medical University of LublinUniwersytecki Szpital Kliniczny Nr 1LublinPoland
| | - Katarzyna Gęca
- Department of Surgical Oncology of the Medical University of LublinUniwersytecki Szpital Kliniczny Nr 1LublinPoland
| | - Magdalena Skórzewska
- Department of Surgical Oncology of the Medical University of LublinUniwersytecki Szpital Kliniczny Nr 1LublinPoland
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Ramos MFKP, Gusmão JS, Pereira MA, Ribeiro-Junior U. Textbook outcome for evaluating the surgical quality of gastrectomy. J Surg Oncol 2024; 130:769-775. [PMID: 39572915 DOI: 10.1002/jso.27750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 05/16/2024] [Accepted: 05/26/2024] [Indexed: 12/13/2024]
Abstract
BACKGROUND The textbook outcome (TO) is an indicator to evaluate surgical quality based on clinical, pathological, and surgical outcomes. OBJECTIVE To analyze the frequency, factors associated with achievement, and the prognostic impact of TO in gastric cancer treatment. METHODS Retrospective analysis of patients with gastric cancer operated with curative intent from 2009 to 2022 in a reference Cancer Center. RESULTS During the period, 681 patients were included and 444 (65.2%) achieved TO. Major surgical complications were the most common not-achieved outcome (16.4%) and intraoperative complications were the most achieved (96.2%). Most of the patients have failed in only 1 outcome (n = 105, 44.3%). Failure to achieve TO was associated with Charlson-Deyo comorbidity index ≥1 (46.4% vs 34.7%, p = 0.003), American Society of Anesthesiologists classification III/IV (40.1% vs 24.1%, p < 0.001), higher mean neutrophil-to-lymphocyte ratio (2.7 vs 3.3, p = 0.024), D1 lymphadenectomy (26.2% vs 15.8%, p = 0.001), and elective postoperative Intensive Care Unit admission (46.4% vs 38.5%, p = 0.046). Disease-free and overall survival (both p < 0.001) were higher in the TO group even after the exclusion of cases with surgical mortality (p = 0.013 and p = 0.024, respectively). CONCLUSIONS TO was achieved in most of the cases and its failure was associated with poor clinical performance and it impacts both early surgical results as well as long-term survival.
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Affiliation(s)
- Marcus F K P Ramos
- Department of Gastroenterology Hospital das Clinicas HCFMUSP, Cancer Institute, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Júlia Siman Gusmão
- Department of Gastroenterology Hospital das Clinicas HCFMUSP, Cancer Institute, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Marina A Pereira
- Department of Gastroenterology Hospital das Clinicas HCFMUSP, Cancer Institute, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Ulysses Ribeiro-Junior
- Department of Gastroenterology Hospital das Clinicas HCFMUSP, Cancer Institute, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
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9
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Realis Luc M, de Pascale S, Ascari F, Bonomi AM, Bertani E, Cella CA, Gervaso L, Fumagalli Romario U. Textbook outcome as indicator of surgical quality in a single Western center: results from 300 consecutive gastrectomies. Updates Surg 2024; 76:1357-1364. [PMID: 38145422 DOI: 10.1007/s13304-023-01727-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 12/01/2023] [Indexed: 12/26/2023]
Abstract
Textbook outcome (TO) has been proposed as a tool to evaluate surgical quality. Textbook oncological outcome (TOO) adds chemotherapeutic compliance to TO. This study was conducted to analyze the TO and TOO of patients with gastric adenocarcinoma who underwent surgery at our center. Data from a prospective database of patients operated on for gastric adenocarcinoma between September 2018 and September 2022 were analyzed. Postoperative management followed Enhanced Recovery After Surgery guidelines. The Dutch Upper Gastrointestinal Cancer Audit group defined TO as a multidimensional measure (10 items). TOO also considers guideline-accordant chemotherapeutic compliance. Three hundred patients underwent surgery during the study period (167 men, 133 women). One hundred seventy-six (58.7%) reached TO. Achieving TO was influenced by patients' comorbidities, calculated via the Charlson Comorbidity Score (3 vs. 4; p = 0.002) and surgery type (subtotal gastrectomy; p < 0.001), but not by the American Society of Anesthesiologists (ASA) score (p = 0.057) or surgical approach (laparoscopic vs. open; p = 0.208). The analysis of TOO included 213 patients. Of these, 71 (33%) underwent complete adequate systemic treatment. Compared with the non-TOO group, patients who achieved TOO had a lower median age (64 vs. 73 years; p < 0.001) and lower ASA score (p < 0.001) and more frequently underwent preoperative chemotherapy (p < 0.001). Our results represent the experience of a single team at a high-volume Western institute. Patients' comorbidities and surgery type influenced whether TO was achieved. Conversely, younger age, lower ASA score and preoperative chemotherapy were associated with TOO.
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Affiliation(s)
- Marco Realis Luc
- Digestive Surgery, European Institute of Oncology, IRCCS, Milan, Italy.
- University of Milan, Milan, Italy.
| | | | - Filippo Ascari
- Digestive Surgery, European Institute of Oncology, IRCCS, Milan, Italy
| | - Alessandro Michele Bonomi
- Digestive Surgery, European Institute of Oncology, IRCCS, Milan, Italy
- University of Milan, Milan, Italy
| | - Emilio Bertani
- Digestive Surgery, European Institute of Oncology, IRCCS, Milan, Italy
| | - Chiara Alessandra Cella
- Division of Gastrointestinal and Neuroendocrine Tumors, European Institute of Oncology, IRCCS, Milan, Italy
| | - Lorenzo Gervaso
- Division of Gastrointestinal and Neuroendocrine Tumors, European Institute of Oncology, IRCCS, Milan, Italy
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10
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de Jongh C, Cianchi F, Kinoshita T, Kingma F, Piccoli M, Dubecz A, Kouwenhoven E, van Det M, Mala T, Coratti A, Ubiali P, Turner P, Kish P, Borghi F, Immanuel A, Nilsson M, Rouvelas I, Hӧlzen JP, Rouanet P, Saint-Marc O, Dussart D, Patriti A, Bazzocchi F, van Etten B, Haveman JW, DePrizio M, Sabino F, Viola M, Berlth F, Grimminger PP, Roviello F, van Hillegersberg R, Ruurda J, UGIRA Collaborative Group. Surgical Techniques and Related Perioperative Outcomes After Robot-assisted Minimally Invasive Gastrectomy (RAMIG): Results From the Prospective Multicenter International Ugira Gastric Registry. Ann Surg 2024; 280:98-107. [PMID: 37922237 PMCID: PMC11161237 DOI: 10.1097/sla.0000000000006147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2023]
Abstract
OBJECTIVE To gain insight into the global practice of robot-assisted minimally invasive gastrectomy (RAMIG) and evaluate perioperative outcomes using an international registry. BACKGROUND The techniques and perioperative outcomes of RAMIG for gastric cancer vary substantially in the literature. METHODS Prospectively registered RAMIG cases for gastric cancer (≥10 per center) were extracted from 25 centers in Europe, Asia, and South-America. Techniques for resection, reconstruction, anastomosis, and lymphadenectomy were analyzed and related to perioperative surgical and oncological outcomes. Complications were uniformly defined by the Gastrectomy Complications Consensus Group. RESULTS Between 2020 and 2023, 759 patients underwent total (n=272), distal (n=465), or proximal (n=22) gastrectomy (RAMIG). After total gastrectomy with Roux-en-Y-reconstruction, anastomotic leakage rates were 8% with hand-sewn (n=9/111) and 6% with linear stapled anastomoses (n=6/100). After distal gastrectomy with Roux-en-Y (67%) or Billroth-II-reconstruction (31%), anastomotic leakage rates were 3% with linear stapled (n=11/433) and 0% with hand-sewn anastomoses (n=0/26). Extent of lymphadenectomy consisted of D1+ (28%), D2 (59%), or D2+ (12%). Median nodal harvest yielded 31 nodes (interquartile range: 21-47) after total and 34 nodes (interquartile range: 24-47) after distal gastrectomy. R0 resection rates were 93% after total and 96% distal gastrectomy. The hospital stay was 9 days after total and distal gastrectomy, and was median 3 days shorter without perianastomotic drains versus routine drain placement. Postoperative 30-day mortality was 1%. CONCLUSIONS This large multicenter study provided a worldwide overview of current RAMIG techniques and their respective perioperative outcomes. These outcomes demonstrated high surgical quality, set a quality standard for RAMIG, and can be considered an international reference for surgical standardization.
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Affiliation(s)
- Cas de Jongh
- Department of Surgery, University Medical Center (UMC) Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Fabio Cianchi
- Department of Experimental and Clinical Medicine, University Hospital Careggi, University of Florence, Florence, Italy
| | - Takahiro Kinoshita
- Department of Gastric Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Feike Kingma
- Department of Surgery, University Medical Center (UMC) Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Micaela Piccoli
- Department of Surgery, Civile Baggiovara Hospital, Azienda Ospedaliero-Universitaria (AOU) of Modena, Modena, Italy
| | - Attila Dubecz
- Department of Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nürnberg, Germany
| | | | - Marc van Det
- Department of Surgery, Hospital ZGT Almelo, Almelo, The Netherlands
| | - Tom Mala
- Department of Surgery, Oslo University Hospital, University of Oslo, Norway
| | - Andrea Coratti
- Department of Surgery, Misericordia Hospital Grosseto, Grosseto, Italy
| | - Paolo Ubiali
- Department of Surgery, Hospital Santa Maria degli Angeli, Pordenone, Italy
| | - Paul Turner
- Department of Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Pursnani Kish
- Department of Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Felice Borghi
- Department of Surgery, General Hospital Cuneo, Cuneo, Italy
- Department of Surgery, Candiolo Cancer Institute, Turin, Italy
| | - Arul Immanuel
- Department of Surgery, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Magnus Nilsson
- Department of Upper Abdominal Diseases, Division of Surgery and Oncology, CLINTEC, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Ioannis Rouvelas
- Department of Upper Abdominal Diseases, Division of Surgery and Oncology, CLINTEC, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | | | - Philippe Rouanet
- Department of Surgery, Montpellier Cancer Institute, Montpellier, France
| | - Olivier Saint-Marc
- Department of Surgery, Centre Hospitalier Régional Universitaire Orléans, Orléans, France
| | - David Dussart
- Department of Surgery, Centre Hospitalier Régional Universitaire Orléans, Orléans, France
| | - Alberto Patriti
- Department of Surgery, General Hospital Marche Nord, Pesaro, Italy
| | - Francesca Bazzocchi
- Department of Surgery, San Giovanni Rotondo Hospital IRCCS, San Giovanni Rotondo, Italy
| | - Boudewijn van Etten
- Department of Surgery, UMC Groningen, University of Groningen, The Netherlands
| | - Jan W. Haveman
- Department of Surgery, UMC Groningen, University of Groningen, The Netherlands
| | - Marco DePrizio
- Department of Surgery, General Hospital Arezzo, Arezzo, Italy
| | - Flávio Sabino
- Department of Surgery, National Cancer Institute Rio de Janeiro, Rio de Janeiro, Brasil
| | - Massimo Viola
- Department of Surgery, General Hospital Tricase, Tricase, Italy
| | - Felix Berlth
- Department of Surgery, UMC Mainz, Mainz, Germany
| | | | - Franco Roviello
- Department of Surgery, University Hospital Siena, Siena, Italy
| | - Richard van Hillegersberg
- Department of Surgery, University Medical Center (UMC) Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Jelle Ruurda
- Department of Surgery, University Medical Center (UMC) Utrecht, University of Utrecht, Utrecht, The Netherlands
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11
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Oh SG, Lee S, Seong BO, Ko CS, Min SH, Gong CS, Kim BS, Yoo MW, Yook JH, Lee IS. Textbook Outcome of Delta-Shaped Anastomosis in Minimally Invasive Distal Gastrectomy for Gastric Cancer in 4,505 Consecutive Patients. J Gastric Cancer 2024; 24:341-352. [PMID: 38960892 PMCID: PMC11224722 DOI: 10.5230/jgc.2024.24.e29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 06/23/2024] [Accepted: 06/24/2024] [Indexed: 07/05/2024] Open
Abstract
PURPOSE Textbook outcome is a comprehensive measure used to assess surgical quality and is increasingly being recognized as a valuable evaluation tool. Delta-shaped anastomosis (DA), an intracorporeal gastroduodenostomy, is a viable option for minimally invasive distal gastrectomy in patients with gastric cancer. This study aims to evaluate the surgical outcomes and calculate the textbook outcome of DA. MATERIALS AND METHODS In this retrospective study, the records of 4,902 patients who underwent minimally invasive distal gastrectomy for DA between 2009 and 2020 were reviewed. The data were categorized into three phases to analyze the trends over time. Surgical outcomes, including the operation time, length of post-operative hospital stay, and complication rates, were assessed, and the textbook outcome was calculated. RESULTS Among 4,505 patients, the textbook outcome is achieved in 3,736 (82.9%). Post-operative complications affect the textbook outcome the most significantly (91.9%). The highest textbook outcome is achieved in phase 2 (85.0%), which surpasses the rates of in phase 1 (81.7%) and phase 3 (82.3%). The post-operative complication rate within 30 d after surgery is 8.7%, and the rate of major complications exceeding the Clavien-Dindo classification grade 3 is 2.4%. CONCLUSIONS Based on the outcomes of a large dataset, DA can be considered safe and feasible for gastric cancer.
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Affiliation(s)
- Seul-Gi Oh
- Division of Gastrointestinal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Surgery, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | - Suin Lee
- Division of Gastrointestinal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ba Ool Seong
- Division of Gastrointestinal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang Seok Ko
- Division of Gastrointestinal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sa-Hong Min
- Division of Gastrointestinal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chung Sik Gong
- Division of Gastrointestinal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Beom Su Kim
- Division of Gastrointestinal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Moon-Won Yoo
- Division of Gastrointestinal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Hwan Yook
- Division of Gastrointestinal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In-Seob Lee
- Division of Gastrointestinal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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12
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Huang ZN, Zheng CY, Wu J, Tang YH, Qiu WW, He QC, Lin GS, Chen QY, Lu J, Wang JB, Cao LL, Lin M, Tu RH, Xie JW, Li P, Lin W, Huang CM, Lin JX, Zheng CH. Textbook oncological outcomes and prognosis after curative gastrectomy in advanced gastric cancer: A multicenter study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108280. [PMID: 38537365 DOI: 10.1016/j.ejso.2024.108280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/16/2024] [Accepted: 03/18/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND The impact of achieving textbook oncological outcome (TOO) as a multimodal therapy quality indicator on the prognosis of advanced gastric cancer (AGC) remains inadequately assessed. METHODS Patients with AGC who underwent curative gastrectomy between January 2010 and December 2017 at two East Asian medical centers were included. TOO was defined as achieving the textbook outcome (TO) and receiving neoadjuvant and/or adjuvant chemotherapy (NCT or ACT). Cox and logistic regression models were used to identify prognostic and non-TOO-associated risk factors. RESULTS Among 3626 patients, 57.6% achieved TOO (TOO group), exhibiting significantly better 5-year overall survival (OS) and disease-free survival (DFS) than the non-TOO group (both p < 0.05). Multivariate Cox regression identified TOO as an independent prognostic factor for 5-year OS (HR, 0.67; 95% CI, 0.61-0.74; p < 0.001) and DFS (HR, 0.73; 95% CI, 0.66-0.81; p < 0.001). Multivariate logistic regression showed that open gastrectomy, lack of health insurance, age ≥65 years, ASA score ≥ Ⅲ, and tumor size ≥50 mm are independent risk factors for non-achievement of TOO (all p < 0.05). On a sensitivity analysis of TOO's prognostic value using varying definitions of chemotherapy parameters, a stricter definition of chemotherapy resulted in a decrease in the TOO achievement rate from 57.6 to 22.3%. However, the associated reductions in the risk of death and recurrence fluctuated within the ranges of 33-39% and 28-37%, respectively. CONCLUSIONS TOO is a reliable and stable metric for favorable prognosis in AGC. Optimizing the surgical approach and improving health insurance status may enhance TOO achievement.
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Affiliation(s)
- Ze-Ning Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou, China
| | - Chang-Yue Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou, China; Department of Gastrointestinal Surgery, The Affiliated Hospital of Putian University, Putian, China
| | - Ju Wu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou, China; Department of General Surgery, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Yi-Hui Tang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou, China
| | - Wen-Wu Qiu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou, China
| | - Qi-Chen He
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou, China
| | - Guo-Sheng Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou, China
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou, China
| | - Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou, China
| | - Jia-Bin Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou, China
| | - Long-Long Cao
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou, China
| | - Mi Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou, China
| | - Ru-Hong Tu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou, China
| | - Wei Lin
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Putian University, Putian, China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou, China.
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou, China.
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou, China.
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13
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Zohar N, Nevler A, Esquivel J, Yeo CJ, Benvenisti H, Elbaz N, Assaf D, Mor E, Bowne WB. International Expert Consensus on Defining Textbook Oncologic Outcomes in Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Colorectal Peritoneal Metastasis. J Am Coll Surg 2024; 238:387-401. [PMID: 38149780 DOI: 10.1097/xcs.0000000000000937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
BACKGROUND Textbook oncologic outcome (TOO) is a composite metric shown to correlate with improved survival after curative intent oncologic procedures. Despite increasing use among disciplines in surgical oncology, no consensus exists for its definition in cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). STUDY DESIGN An international consensus-based study employed a Delphi methodology to achieve agreement. Fifty-four senior surgeons from the peritoneal surface malignancies field received a questionnaire comprising TOO parameters divided into 3 surgical domains: operative, short-term, and long-term postoperative outcomes. Two online meetings with participants defined the new criteria. Consensus was achieved when 75% of agreement rate was reached. Clinical data of patients who underwent CRS and HIPEC for colorectal peritoneal metastasis between 2010 and 2022 from 1 designated center (Sheba Medical Center) were collected, the consensus definition applied and outcomes analyzed. RESULTS Thirty-eight surgeons (70%) participated. Expert consensus TOO parameters for colorectal peritoneal metastasis CRS and HIPEC included the absence of unplanned reoperations during 30 days postoperation, absence of severe postoperative complications (Clavien-Dindo ≥III), absence of unplanned readmissions during 30 days postoperation, 90-day postoperative mortality, and absence of contraindications for chemotherapy within 12 weeks from operation, and included the achievement of complete cytoreduction (CC0). The study cohort consisted of 251 patients, and 151 (60%) met TOO criteria. Patients who achieved TOO had significantly better overall survival (median 67.5 months, 95% CI) vs patients who did not achieve TOO (median 44.6 months, 95% CI, p < 0.001) and significantly improved disease-free survival (median, 12 months, 95% CI, vs 9 months, 95% CI, p = 0.01). CONCLUSIONS Achievement of TOO as defined by consensus statement is associated with improved survival.
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Affiliation(s)
- Nitzan Zohar
- From the Jefferson Pancreas, Biliary and Related Cancer Center, Jefferson Health, Philadelphia, PA (Zohar, Nevler, Yeo, Bowne)
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA (Zohar, Nevler, Yeo, Bowne)
- Department of General and Oncological Surgery-Surgery C, Sheba Medical Center, Tel-Hashomer, Israel (Zohar, Benvenisti, Elbaz, Assaf, Mor)
| | - Avinoam Nevler
- From the Jefferson Pancreas, Biliary and Related Cancer Center, Jefferson Health, Philadelphia, PA (Zohar, Nevler, Yeo, Bowne)
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA (Zohar, Nevler, Yeo, Bowne)
| | | | - Charles J Yeo
- From the Jefferson Pancreas, Biliary and Related Cancer Center, Jefferson Health, Philadelphia, PA (Zohar, Nevler, Yeo, Bowne)
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA (Zohar, Nevler, Yeo, Bowne)
| | - Haggai Benvenisti
- Department of General and Oncological Surgery-Surgery C, Sheba Medical Center, Tel-Hashomer, Israel (Zohar, Benvenisti, Elbaz, Assaf, Mor)
| | - Nadav Elbaz
- Department of General and Oncological Surgery-Surgery C, Sheba Medical Center, Tel-Hashomer, Israel (Zohar, Benvenisti, Elbaz, Assaf, Mor)
| | - Dan Assaf
- Department of General and Oncological Surgery-Surgery C, Sheba Medical Center, Tel-Hashomer, Israel (Zohar, Benvenisti, Elbaz, Assaf, Mor)
| | - Eyal Mor
- Department of General and Oncological Surgery-Surgery C, Sheba Medical Center, Tel-Hashomer, Israel (Zohar, Benvenisti, Elbaz, Assaf, Mor)
| | - Wilbur B Bowne
- From the Jefferson Pancreas, Biliary and Related Cancer Center, Jefferson Health, Philadelphia, PA (Zohar, Nevler, Yeo, Bowne)
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA (Zohar, Nevler, Yeo, Bowne)
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14
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Tagkalos E, Grimminger P, Gao X, Chiu CH, Uzun E, Lang H, Wen YW, Chao YK. Incidence and Predictors of Textbook Outcome after Minimally Invasive Esophagectomy for Cancer: A Two-Center Study. Cancers (Basel) 2024; 16:1109. [PMID: 38539444 PMCID: PMC10968568 DOI: 10.3390/cancers16061109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 02/28/2024] [Accepted: 03/07/2024] [Indexed: 11/11/2024] Open
Abstract
PURPOSE The textbook outcome (TBO), a multidimensional indicator that reflects an optimal perioperative course, has emerged as a significant prognostic variable in surgical oncology. Our study aimed to assess the occurrence and determinants of TBO following minimally invasive esophagectomy (MIE) for cancer. METHODS A total of 945 patients who had undergone MIE at two high-volume centers between 2008 and 2022 were analyzed. Multivariable logistic regression analysis was applied to identify the independent predictors of TBO. The potential selection bias associated with choosing between different MIE techniques-namely, robotic esophagectomy (RE) and video-assisted thoracoscopic esophagectomy (VATE)-was addressed by applying inverse probability of treatment weighting (IPTW). RESULTS TBO was realized in 46.6% of cases (n = 440), correlating with markedly better overall and disease-free survival. Multivariable analysis showed that treatment with RE (odds ratio (OR) = 1.527; 95% confidence interval (CI) = 1.149-2.028) was associated with a higher likelihood of achieving TBO, whereas a Charlson Comorbidity Index (CCI) of 2 or higher showed an opposite association (CCI2: OR = 0.687, 95% CI = 0.483-0.977; CCI ≥ 3: OR = 0.604, 95% CI = 0.399-0.915). The advantage of RE in attaining a higher rate of TBO, compared to VATE, remained statistically significant after applying IPTW, with rates of 53.3% for RE and 42.2% for VATE. Notably, RE contributed to a greater probability of thorough lymph node dissection, resection with negative margins, and the avoidance of major complications. CONCLUSION TBO was realized in 46.6% of the patients who underwent MIE for cancer. Patients with a lower CCI and those who received RE were more likely to achieve TBO.
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Affiliation(s)
- Evangelos Tagkalos
- Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linkou, Chang Gung University, Taoyuan 33302, Taiwan; (E.T.); (X.G.); (C.-H.C.)
- Clinic of General, Visceral and Transplant Surgery, University Medical Center Mainz, 55131 Mainz, Germany; (P.G.); (E.U.); (H.L.)
| | - Peter Grimminger
- Clinic of General, Visceral and Transplant Surgery, University Medical Center Mainz, 55131 Mainz, Germany; (P.G.); (E.U.); (H.L.)
| | - Xing Gao
- Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linkou, Chang Gung University, Taoyuan 33302, Taiwan; (E.T.); (X.G.); (C.-H.C.)
| | - Chien-Hung Chiu
- Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linkou, Chang Gung University, Taoyuan 33302, Taiwan; (E.T.); (X.G.); (C.-H.C.)
| | - Eren Uzun
- Clinic of General, Visceral and Transplant Surgery, University Medical Center Mainz, 55131 Mainz, Germany; (P.G.); (E.U.); (H.L.)
| | - Hauke Lang
- Clinic of General, Visceral and Transplant Surgery, University Medical Center Mainz, 55131 Mainz, Germany; (P.G.); (E.U.); (H.L.)
| | - Yu-Wen Wen
- Department of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan;
| | - Yin-Kai Chao
- Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linkou, Chang Gung University, Taoyuan 33302, Taiwan; (E.T.); (X.G.); (C.-H.C.)
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15
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Lin X, Tan C, Wu W, Liang C, Qian F, Zhao Y. Evaluation of factors influencing long-term and textbook outcomes in laparoscopic gastrectomy. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108002. [PMID: 38330541 DOI: 10.1016/j.ejso.2024.108002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/05/2024] [Accepted: 02/02/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Textbook outcome (TO) in gastric cancer surgery is a multidimensional measure of surgical quality. However, its impact on long-term survival after laparoscopic gastrectomy (LG) is unclear. This study aims to evaluate TO in LG, assess its hospital-level relevance, and examine its association with long-term survival. METHODS In this retrospective cohort study, we analyzed 2278 consecutive gastric cancer patients who underwent laparoscopic gastrectomy (LG) from January 2004 to December 2017. We determined TO achievement rates, compared preoperative and intraoperative variables between TO and non-TO groups, identified independent predictors of TO, and assessed long-term oncologic outcomes using Kaplan-Meier analysis and Cox regression. RESULTS A total of 1540 LG patients were analyzed, with 994 (64.5%) achieving TO. The least frequently achieved metric was 'hospital stays ≤21 days' (83.4%), followed by 'lymph nodes retrieved ≥15' (84.0%). Factors independently associated with reduced TO likelihood included age ≥65 years, BMI ≥25, ASA III, conversion to open surgery, operation time ≥260 min, and estimated blood loss ≥150 ml. Furthermore, TO was independently linked to improved 5-year overall survival (OS) and disease-free survival (DFS) (HR 0.519 [0.443-0.609] and HR 0.517 [0.443-0.604], respectively). CONCLUSION Implementing the TO concept in LG provides a benchmark for achieving improved prognoses and empowers surgeons to devise strategies for enhancing surgical care quality.
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Affiliation(s)
- Xia Lin
- Institution: Department of Gastrointestinal Surgery, Three Gorges Hospital, Chongqing University, Chongqing, China; Institution: Department of General Surgery, the First Affiliated Hospital of the Third Military Medical University, Chongqing, China
| | - Chenjun Tan
- Institution: Department of General Surgery, the First Affiliated Hospital of the Third Military Medical University, Chongqing, China
| | - Weigao Wu
- Institution: Department of General Surgery, the First Affiliated Hospital of the Third Military Medical University, Chongqing, China
| | - Chenglong Liang
- Institution: Department of General Surgery, the First Affiliated Hospital of the Third Military Medical University, Chongqing, China
| | - Feng Qian
- Institution: Department of General Surgery, the First Affiliated Hospital of the Third Military Medical University, Chongqing, China
| | - Yongliang Zhao
- Institution: Department of General Surgery, the First Affiliated Hospital of the Third Military Medical University, Chongqing, China.
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Qiu ZC, Wu YW, Qi WL, Li C. Safety of nighttime elective hepatectomy for hepatocellular carcinoma patients: a retrospective study. Ann Surg Treat Res 2024; 106:68-77. [PMID: 38318090 PMCID: PMC10838651 DOI: 10.4174/astr.2024.106.2.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/10/2023] [Accepted: 11/26/2023] [Indexed: 02/07/2024] Open
Abstract
Purpose This study aimed to investigate whether nighttime elective surgery influenced the short-term outcomes and prognosis of hepatocellular carcinoma (HCC) patients. Methods The 1,339 HCC patients who underwent hepatectomy were divided into the daytime surgery group (8 a.m.-6 p.m., n = 1,105) and the nighttime surgery group (after 6 p.m., n = 234) based on the start time of surgery. The 1:2 propensity score matching (PSM) analysis was used to control confounding factors. The short-term outcomes of HCC patients in the 2 groups were compared before and after PSM. Factors associated with major complications (Clavien-Dindo grade, ≥III) and textbook oncologic outcomes (TOO) were separately identified by multivariable logistic regression based on variables screened via least absolute shrinkage and selection operator (LASSO). The Kaplan-Meier method was used to analyze overall survival (OS) and recurrence-free survival (RFS). Results TOO was achieved after surgery in 897 HCC patients. HCC patients in the nighttime surgery group had a higher body mass index (P = 0.010). After 1:2 PSM, the baseline characteristics of patients between the 2 groups were similar. Short-term outcomes in HCC patients were comparable both before and after PSM (all Ps > 0.05), as were TOO in the 2 groups before (P = 0.673) and after PSM (P = 0.333). In our LASSO-logistic regression, nighttime surgery was not an independent factor associated with major complications or TOO. Both groups also had similar OS (P = 0.950) and RFS (P = 0.740) after PSM. Conclusion Our study revealed the safety of nighttime elective hepatectomy for HCC patients.
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Affiliation(s)
- Zhan-cheng Qiu
- Division of Liver Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - You-wei Wu
- Division of Liver Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Wei-li Qi
- Division of Liver Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Chuan Li
- Division of Liver Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
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Bobrzynski L, Sędłak K, Rawicz-Pruszyński K, Kolodziejczyk P, Szczepanik A, Polkowski W, Richter P, Sierzega M. Evaluation of optimum classification measures used to define textbook outcome among patients undergoing curative-intent resection of gastric cancer. BMC Cancer 2023; 23:1199. [PMID: 38057839 DOI: 10.1186/s12885-023-11695-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 11/29/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Textbook outcome (TO) is a composite measure reflecting various aspects of services provided to patients with solid malignancies. We sought to evaluate the importance of various TO components previously proposed for gastric cancer. METHODS Prospectively maintained electronic databases of 1,743 patients treated in two academic surgical centres were reviewed. Six candidate definitions of TO were evaluated based on their ability to accurately predict patients' prognosis by Cox proportional hazards modelling. RESULTS TO definition combining 10 measures corresponding to complete tumour resection with an uneventful postoperative course showed the best goodness of fit by achieving the lowest values of Akaike (AIC) and Bayesian (BIC) information criteria and the best predictive performance based on the highest value of c-index. The overall median survival was significantly longer for patients with than without textbook outcome (69.0 vs 20.1 months, P < 0.001). TO maintained its prognostic value in a multivariate model controlling for age, sex, comorbidities, treatment, and tumour related variables and was associated with a 39% lower risk of death (HR 0.61, 95%CI 0.51 - 0.73, P < 0.001). Nine variables identified as predictors of TO were used to develop a nomogram showing very good correlation between the predicted and actual probability of achieving TO. The AUC of ROC obtained from the nomogram was 0.752 (95% CI 0.727 to 0.781). CONCLUSIONS A uniform definition of textbook outcome provides clinically relevant prognostic information and could be used in quality improvement programs for gastric cancer patients.
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Affiliation(s)
- L Bobrzynski
- First Department of Surgery, Jagiellonian University Medical College, 2 Jakubowskiego Street, Krakow, 30-688, Poland
| | - K Sędłak
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | - K Rawicz-Pruszyński
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | - P Kolodziejczyk
- First Department of Surgery, Jagiellonian University Medical College, 2 Jakubowskiego Street, Krakow, 30-688, Poland
| | - A Szczepanik
- First Department of Surgery, Jagiellonian University Medical College, 2 Jakubowskiego Street, Krakow, 30-688, Poland
| | - W Polkowski
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | - P Richter
- First Department of Surgery, Jagiellonian University Medical College, 2 Jakubowskiego Street, Krakow, 30-688, Poland
| | - M Sierzega
- First Department of Surgery, Jagiellonian University Medical College, 2 Jakubowskiego Street, Krakow, 30-688, Poland.
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D'Souza J, McCombie A, Roberts R. The influence of short-term postoperative outcomes on overall survival after gastric cancer surgery. ANZ J Surg 2023; 93:2875-2884. [PMID: 37489633 DOI: 10.1111/ans.18613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/04/2023] [Accepted: 07/04/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Gastrectomy with lymphadenectomy in combination with perioperative chemotherapy is the cornerstone of modern curative treatment for gastric adenocarcinoma. The primary objective of this study was to assess the influence of textbook outcome, postoperative complications, and readmission on survival in patients who underwent gastric cancer surgery. METHODS Consecutive patients who underwent curative and prophylactic gastric resections from 2014 to 2022 at Christchurch Hospital were identified from the hospital database. Multivariable analyses were performed to assess risk factors for each postoperative outcome. A survival analysis was performed to evaluate the influence of these outcomes on overall survival. RESULTS Seventy-seven patients underwent a gastric resection during the study period. Thirteen were prophylactic resections for E-cadherin gene mutations and 64 were for malignancy. The overall postoperative complication rate was 34%, with an anastomotic leak rate of 8% (n = 6). The 30-day readmission rate, 30-day mortality rate and 90-day mortality rate were 17%, 1%, and 5% respectively. No sociodemographic differences were identified in each outcome. An increasing day-4 CRP trajectory was observed in patients with an anastomotic leak. Postoperative complications and nodal disease were independent prognostic factors for reduced survival. CONCLUSIONS Textbook outcome, postoperative complications, and readmission are validated quality performance indicators of gastric cancer surgery. Postoperative complications are associated with poor overall survival independent of severity or type. The underlying mechanisms of this influence remain elusive. The aggressive biology of gastric cancer, combined with the surgical morbidity and its negative influence on survival, highlights the importance of ongoing quality improvement.
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Affiliation(s)
- Joel D'Souza
- Department of General Surgery, Te Whatu Ora - Waitaha Canterbury, Christchurch, New Zealand
| | - Andrew McCombie
- Department of General Surgery, Te Whatu Ora - Waitaha Canterbury, Christchurch, New Zealand
| | - Ross Roberts
- Department of General Surgery, Te Whatu Ora - Waitaha Canterbury, Christchurch, New Zealand
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Reis ME, Ulusahin M, Cekic AB, Usta MA, Guner A. Does surgeon specialization add value to surgeon volume in gastric cancer surgery? EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:107091. [PMID: 37757682 DOI: 10.1016/j.ejso.2023.107091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 08/07/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND This study aimed to assess the combined impact of surgeon specialization and surgeon volume on both short- and long-term outcomes in patients underwent curative gastrectomy for gastric cancer. METHODS Patients with cStage1-3 gastric adenocarcinoma who underwent curative-intent surgery between January 2010 and December 2020 were evaluated. The impact of surgeon specialization and surgeon volume on clinical outcomes was scrutinized, both individually and in combination. For the purpose of assessing the combined effect, surgeons were classified into three groups: Non-specialized low-volume (NS-low), non-specialized high-volume (NS-high), and specialized high-volume (S-high). Postoperative outcomes and survival were evaluated. The adjusted effect sizes were expressed as odds ratio (OR) or hazard ratio (HR) with the corresponding 95% confidence interval. RESULTS Total of 537 patients operated by twelve surgeons were included in the analysis. For all cohort, the 30d-, in-hospital and 90d-mortality were 3.5%, 3%, and 6.3%, respectively. High surgeon volume alone had a significant impact (OR: 0.31 [0.10-0.82, p = 0.023]) on 30-day mortality. However, upon evaluating the combined effects of the parameters, while the most favorable 30-day mortality rate was observed in the S-high group, neither the NS-low group (OR: 3.82 [1.10-18.17, p = 0.054]) nor the NS-high group (OR: 1.37 [0.23-8.37, p = 0.724]) demonstrated a statistically significant difference when compared to the S-high group. The NS-low group showed poor results for several types of postoperative outcomes. In terms of overall survival, the S-high group outperformed, while the NS-low and NS-high groups presented with notably worse outcomes (HRs: 2.04 [1.51-2.75, p < 0.001], and 1.75 [1.25-2.44, p = 0.001], respectively). CONCLUSION The primary factor influencing short-term outcomes for patients who underwent gastric cancer surgery was found to be surgeon volume, while specialization provided a limited additional value. However, specialization emerges as an independent factor with a greater contribution to long-term survival than the impact attributed to high-volume.
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Affiliation(s)
- Murat Emre Reis
- Karadeniz Technical University, Faculty of Medicine, Department of General Surgery, Trabzon, Turkey
| | - Mehmet Ulusahin
- Karadeniz Technical University, Faculty of Medicine, Department of General Surgery, Trabzon, Turkey
| | - Arif Burak Cekic
- Karadeniz Technical University, Faculty of Medicine, Department of General Surgery, Trabzon, Turkey
| | - Mehmet Arif Usta
- Karadeniz Technical University, Faculty of Medicine, Department of General Surgery, Trabzon, Turkey
| | - Ali Guner
- Karadeniz Technical University, Faculty of Medicine, Department of General Surgery, Trabzon, Turkey; Karadeniz Technical University, Institute of Medical Science, Department of Biostatistics and Medical Informatics, Trabzon, Turkey.
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Sędłak K, Rawicz-Pruszyński K, Mlak R, Van Sandick J, Gisbertz S, Pera M, Dal Cero M, Baiocchi GL, Celotti A, Morgagni P, Vittimberga G, Hoelscher A, Moenig S, Kołodziejczyk P, Richter P, Gockel I, Piessen G, Da Costa PM, Davies A, Baker C, Allum W, Romario UF, De Pascale S, Rosati R, Reim D, Santos LL, D'ugo D, Wijnhoven B, Degiuli M, De Manzoni G, Kielan W, Frejlich E, Schneider P, Polkowski WP. Textbook Oncological Outcome in European GASTRODATA. Ann Surg 2023; 278:823-831. [PMID: 37555342 DOI: 10.1097/sla.0000000000006054] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
OBJECTIVE To assess the rate of textbook outcome (TO) and textbook oncological outcome (TOO) in the European population based on the GASTRODATA registry. BACKGROUND TO is a composite parameter assessing surgical quality and strongly correlates with improved overall survival. Following the standard of treatment for locally advanced gastric cancer, TOO was proposed as a quality and optimal multimodal treatment parameter. METHODS TO was achieved when all the following criteria were met: no intraoperative complications, radical resection according to the surgeon, pR0 resection, retrieval of at least 15 lymph nodes, no severe postoperative complications, no reintervention, no admission to the intensive care unit, no prolonged length of stay, no postoperative mortality and no hospital readmission. TOO was defined as TO with the addition of perioperative chemotherapy compliance. RESULTS Of the 2558 patients, 1700 were included in the analysis. TO was achieved in 1164 (68.5%) patients. The use of neoadjuvant chemotherapy [odds ratio (OR) = 1.33, 95% CI: 1.04-1.70] and D2 or D2+ lymphadenectomy (OR = 1.55, 95% CI: 1.15-2.10) had a positive impact on TO achievement. Older age (OR = 0.73, 95% CI: 0.54-0.94), pT3/4 (OR = 0.79, 95% CI: 0.63-0.99), ASA 3/4 (OR = 0.68, 95% CI: 0.54-0.86) and total gastrectomy (OR = 0.56, 95% CI: 0.45-0.70), had a negative impact on TO achievement. TOO was achieved in 388 (22.8%) patients. Older age (OR = 0.37, 95% CI: 0.27-0.53), pT3 or pT4 (OR = 0.52, 95% CI: 0.39-0.69), and ASA 3 or 4 (OR = 0.58, 95% CI: 0.43-0.79) had a negative impact on TOO achievement. CONCLUSIONS Despite successively improved surgical outcomes, stage-appropriate chemotherapy in adherence to the current guidelines for multimodal treatment of gastric cancer remains poor. Further implementation of oncologic quality metrics should include greater emphasis on perioperative chemotherapy and adequate lymphadenectomy.
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Affiliation(s)
- Katarzyna Sędłak
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | | | - Radosław Mlak
- Department of Preclinical Sciences, Body Composition Research Laboratory, Medical University of Lublin, Lublin, Poland
| | - Johanna Van Sandick
- Department of Surgical Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Suzanne Gisbertz
- Department of Surgery, University Medical Center, Amsterdam, The Netherlands
| | - Manuel Pera
- Department of Digestive Surgery, Hospital Universitario del Mar, Barcelona, Spain
| | - Mariagiulia Dal Cero
- Department of Digestive Surgery, Hospital Universitario del Mar, Barcelona, Spain
| | - Gian Luca Baiocchi
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, and Third Division of General Surgery, Spedali Civili di Brescia, Brescia, Italy
| | - Andrea Celotti
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, and Third Division of General Surgery, Spedali Civili di Brescia, Brescia, Italy
| | - Paolo Morgagni
- Department of General Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy
| | | | | | - Stefan Moenig
- Department of General, Visceral and Thoracic Surgery, Agaplesion Markus Hospital, Frankfurt, Germany
| | | | - Piotr Richter
- Department of Surgery, Jagiellonian University Medical College
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, University Lille, and Claude Huriez University Hospital, Lille, France
| | | | - Andrew Davies
- Department of Upper Gastrointestinal and General Surgery, Guy's and St Thomas' Hospital, London, UK; School of Cancer and Pharmaceutical Sciences, King's College; Department of Molecular Medicine and Surgery and Upper Gastrointestinal Surgery, Karolinska Institute, Stockholm, Sweden, London, UK
| | - Cara Baker
- Department of Upper Gastrointestinal and General Surgery, Guy's and St Thomas' Hospital, London, UK; School of Cancer and Pharmaceutical Sciences, King's College; Department of Molecular Medicine and Surgery and Upper Gastrointestinal Surgery, Karolinska Institute, Stockholm, Sweden, London, UK
| | - William Allum
- Department of Surgery, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | | | - Ricccardo Rosati
- Department of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy
| | - Daniel Reim
- Department of Surgery, TUM School of Medicine, Technical University of Munich, Germany
| | - Lucio Lara Santos
- Department of Surgical Oncology, Experimental Pathology and Therapeutics Group, Portuguese Institute Of Oncology, Porto, Portugal
| | - Domenico D'ugo
- Department of General Surgery, Fondazione Policlinico Gemelli, Rome, Italy
| | - Bas Wijnhoven
- Department of General Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Maurizio Degiuli
- Surgical Oncology and Digestive Surgery, Department of Oncology, University of Turin, San Luigi University Hospital, Orbassano, Turin 10049, Italy
| | - Giovanni De Manzoni
- Department of Surgery, General and Upper G.I. Surgery Division, University of Verona, Verona, Italy
| | - Wojciech Kielan
- Department of General and Oncological Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Ewelina Frejlich
- Department of General and Oncological Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Paul Schneider
- Department of Infectious Diseases and Pulmonary Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
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Carbonell-Morote S, Yang HK, Lacueva J, Rubio-García JJ, Alacan-Friedrich L, Fierley L, Villodre C, Ramia JM. Textbook outcome in oncological gastric surgery: a systematic review and call for an international consensus. World J Surg Oncol 2023; 21:288. [PMID: 37697286 PMCID: PMC10496160 DOI: 10.1186/s12957-023-03166-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 09/02/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Textbook outcome (TO) is a multidimensional measure used to assess the quality of surgical practice. It is a reflection of an "ideal" surgical result, based on a series of benchmarks or established reference points that may vary depending on the pathology in question. References to TO in the literature are scarce, and the few reports that are available were all published very recently. In the case of gastric surgery, there is no established consensus on the parameters that should be included in TO, a circumstance that prevents comparison between series. AIM To present a review of the literature on TO in gastric surgery (TOGS) and to try to establish a consensus on its definition. MATERIAL AND METHODS Following the PRISMA guide, we performed an unlimited search for articles on TOGS in the MEDLINE (PubMed), EMBASE and Cochrane, Latindex, Scielo, and Koreamed databases, without language restriction, updated on December 31, 2022. The inclusion criterion was any type of study assessing TO in adult patients after oncological gastric surgery. Selected studies were assessed, and TOGS was measured. The parameters used to assess the achievement of TOGS in selected studies were also recorded. RESULTS Twelve articles were included, comprising a total of 44,581 patients who had undergone an oncological gastric resection. The median rate of TOGS was 38.6%. All the publications but one included mortality as a TO variable, showing statistically significant differences in favor of the group in which TOGS was achieved. All articles included the number of nodes examined in the surgical specimen, with the assessment of fewer than 15 being associated with a low rate of TOGS achievement in five studies (41.7%). The variable postoperative complications according to the Clavien-Dindo score was the most important cause of failure to achieve TOGS in four studies (33.3%). Seven articles (58.3%) found a significant increase in long-term survival in patients who obtained TO. Advanced age, elevated ASA, and Charlson score had a negative impact on obtaining TOGS. CONCLUSIONS The standardization of TOGS is necessary to be able to establish comparable results between groups.
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Affiliation(s)
- Silvia Carbonell-Morote
- Department of Surgery, Hospital General Universitario Dr. Balmis, Avenida Pintor Baeza, 11, 03010, Alicante, Spain
- ISABIAL, Alicante, Spain
| | - Han-Kwang Yang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Javier Lacueva
- Universidad Miguel Hernández, Alicante, Spain
- Hospital General Universitario de Elche, Elche, Spain
| | - Juan Jesús Rubio-García
- Department of Surgery, Hospital General Universitario Dr. Balmis, Avenida Pintor Baeza, 11, 03010, Alicante, Spain
- ISABIAL, Alicante, Spain
| | | | | | - Celia Villodre
- Department of Surgery, Hospital General Universitario Dr. Balmis, Avenida Pintor Baeza, 11, 03010, Alicante, Spain
- ISABIAL, Alicante, Spain
| | - Jose M Ramia
- Department of Surgery, Hospital General Universitario Dr. Balmis, Avenida Pintor Baeza, 11, 03010, Alicante, Spain.
- ISABIAL, Alicante, Spain.
- Universidad Miguel Hernández, Alicante, Spain.
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