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Textbook Outcome after Gastrectomy for Gastric Cancer Is Associated with Improved Overall and Disease-Free Survival

(1) Background: The complexity of the perioperative outcome for patients with gastric cancer is not well reflected by single quality metrics. To study the effect of the surgical outcome on survival, we have evaluated the relationship between textbook outcome (TO)—a new composite parameter—and oncolo...

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Autores principales: Çetinkaya-Hosgör, Candan, Seika, Philippa, Raakow, Jonas, Kröll, Dino, Dobrindt, Eva Maria, Maurer, Max Magnus, Martin, Friederike, Ossami Saidy, Ramin Raul, Thuss-Patience, Peter, Pratschke, Johann, Biebl, Matthias, Denecke, Christian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10455280/
https://www.ncbi.nlm.nih.gov/pubmed/37629461
http://dx.doi.org/10.3390/jcm12165419
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author Çetinkaya-Hosgör, Candan
Seika, Philippa
Raakow, Jonas
Kröll, Dino
Dobrindt, Eva Maria
Maurer, Max Magnus
Martin, Friederike
Ossami Saidy, Ramin Raul
Thuss-Patience, Peter
Pratschke, Johann
Biebl, Matthias
Denecke, Christian
author_facet Çetinkaya-Hosgör, Candan
Seika, Philippa
Raakow, Jonas
Kröll, Dino
Dobrindt, Eva Maria
Maurer, Max Magnus
Martin, Friederike
Ossami Saidy, Ramin Raul
Thuss-Patience, Peter
Pratschke, Johann
Biebl, Matthias
Denecke, Christian
author_sort Çetinkaya-Hosgör, Candan
collection PubMed
description (1) Background: The complexity of the perioperative outcome for patients with gastric cancer is not well reflected by single quality metrics. To study the effect of the surgical outcome on survival, we have evaluated the relationship between textbook outcome (TO)—a new composite parameter—and oncological outcome. (2) Methods: All patients undergoing total gastrectomy or trans-hiatal extended gastrectomy for gastric cancer with curative intent between 2017 and 2021 at our institution were included. TO was defined by negative resection margins (R0); collection of ≥25 lymph nodes; the absence of major perioperative complications (Clavien–Dindo ≥ 3); the absence of any reintervention; absence of unplanned ICU re-admission; length of hospital stay < 21 days; absence of 30-day readmission and 30-day mortality. We evaluated factors affecting TO by multivariate logistic regression. The correlation between TO and long-term survival was assessed using a multivariate cox proportional-hazards model. (3) Results: Of the patients included in this study, 52 (52.5 %) achieved all TO metrics. Open surgery (p = 0.010; OR 3.715, CI 1.334–10.351) and incomplete neoadjuvant chemotherapy (p = 0.020, OR 4.278, CI 1.176–15.553) were associated with failure to achieve TO on multivariate analysis. The achievement of TO significantly affected overall survival (p = 0.015). TO (p = 0.037, OD 0.448, CI 0.211–0.954) and CCI > 4 (p = 0.034, OR 2.844, CI 1.079–7.493) were significant factors affecting DFS upon univariate analysis. In multivariate analysis, CCI > 4 (p = 0.035, OR 2.605, CI 0.983–6.905) was significantly associated with DFS. (4) Conclusions: We identified patient- and procedure-related factors influencing TO. Importantly, achieving TO is strongly associated with improved long-term survival in gastric cancer patients and merits further focus on surgical quality improvement efforts.
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spelling pubmed-104552802023-08-26 Textbook Outcome after Gastrectomy for Gastric Cancer Is Associated with Improved Overall and Disease-Free Survival Çetinkaya-Hosgör, Candan Seika, Philippa Raakow, Jonas Kröll, Dino Dobrindt, Eva Maria Maurer, Max Magnus Martin, Friederike Ossami Saidy, Ramin Raul Thuss-Patience, Peter Pratschke, Johann Biebl, Matthias Denecke, Christian J Clin Med Article (1) Background: The complexity of the perioperative outcome for patients with gastric cancer is not well reflected by single quality metrics. To study the effect of the surgical outcome on survival, we have evaluated the relationship between textbook outcome (TO)—a new composite parameter—and oncological outcome. (2) Methods: All patients undergoing total gastrectomy or trans-hiatal extended gastrectomy for gastric cancer with curative intent between 2017 and 2021 at our institution were included. TO was defined by negative resection margins (R0); collection of ≥25 lymph nodes; the absence of major perioperative complications (Clavien–Dindo ≥ 3); the absence of any reintervention; absence of unplanned ICU re-admission; length of hospital stay < 21 days; absence of 30-day readmission and 30-day mortality. We evaluated factors affecting TO by multivariate logistic regression. The correlation between TO and long-term survival was assessed using a multivariate cox proportional-hazards model. (3) Results: Of the patients included in this study, 52 (52.5 %) achieved all TO metrics. Open surgery (p = 0.010; OR 3.715, CI 1.334–10.351) and incomplete neoadjuvant chemotherapy (p = 0.020, OR 4.278, CI 1.176–15.553) were associated with failure to achieve TO on multivariate analysis. The achievement of TO significantly affected overall survival (p = 0.015). TO (p = 0.037, OD 0.448, CI 0.211–0.954) and CCI > 4 (p = 0.034, OR 2.844, CI 1.079–7.493) were significant factors affecting DFS upon univariate analysis. In multivariate analysis, CCI > 4 (p = 0.035, OR 2.605, CI 0.983–6.905) was significantly associated with DFS. (4) Conclusions: We identified patient- and procedure-related factors influencing TO. Importantly, achieving TO is strongly associated with improved long-term survival in gastric cancer patients and merits further focus on surgical quality improvement efforts. MDPI 2023-08-21 /pmc/articles/PMC10455280/ /pubmed/37629461 http://dx.doi.org/10.3390/jcm12165419 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Çetinkaya-Hosgör, Candan
Seika, Philippa
Raakow, Jonas
Kröll, Dino
Dobrindt, Eva Maria
Maurer, Max Magnus
Martin, Friederike
Ossami Saidy, Ramin Raul
Thuss-Patience, Peter
Pratschke, Johann
Biebl, Matthias
Denecke, Christian
Textbook Outcome after Gastrectomy for Gastric Cancer Is Associated with Improved Overall and Disease-Free Survival
title Textbook Outcome after Gastrectomy for Gastric Cancer Is Associated with Improved Overall and Disease-Free Survival
title_full Textbook Outcome after Gastrectomy for Gastric Cancer Is Associated with Improved Overall and Disease-Free Survival
title_fullStr Textbook Outcome after Gastrectomy for Gastric Cancer Is Associated with Improved Overall and Disease-Free Survival
title_full_unstemmed Textbook Outcome after Gastrectomy for Gastric Cancer Is Associated with Improved Overall and Disease-Free Survival
title_short Textbook Outcome after Gastrectomy for Gastric Cancer Is Associated with Improved Overall and Disease-Free Survival
title_sort textbook outcome after gastrectomy for gastric cancer is associated with improved overall and disease-free survival
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10455280/
https://www.ncbi.nlm.nih.gov/pubmed/37629461
http://dx.doi.org/10.3390/jcm12165419
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