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. 2023 Nov 1;278(5):823-831.
doi: 10.1097/SLA.0000000000006054. Epub 2023 Aug 9.

Textbook Oncological Outcome in European GASTRODATA

Katarzyna Sędłak  1 , Karol Rawicz-Pruszyński  1 , Radosław Mlak  2 , Johanna Van Sandick  3 , Suzanne Gisbertz  4 , Manuel Pera  5 , Mariagiulia Dal Cero  5 , Gian Luca Baiocchi  6 , Andrea Celotti  6 , Paolo Morgagni  7 , Giovani Vittimberga  7 , Arnulf Hoelscher  8 , Stefan Moenig  9 , Piotr Kołodziejczyk  10 , Piotr Richter  10 , Ines Gockel  11 , Guillaume Piessen  12 , Paulo Matos Da Costa  13 , Andrew Davies  14 , Cara Baker  14 , William Allum  15 , Uberto Fumagalli Romario  16 , Stefano De Pascale  16 , Ricccardo Rosati  17 , Daniel Reim  18 , Lucio Lara Santos  19 , Domenico D'ugo  20 , Bas Wijnhoven  21 , Maurizio Degiuli  22 , Giovanni De Manzoni  23 , Wojciech Kielan  24 , Ewelina Frejlich  24 , Paul Schneider  25 , Wojciech P Polkowski  1
Affiliations

Textbook Oncological Outcome in European GASTRODATA

Katarzyna Sędłak et al. Ann Surg. .

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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Conflict of interest statement

The authors report no conflicts of interest.

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