Textbook Outcome of Delta-Shaped Anastomosis in Minimally Invasive Distal Gastrectomy for Gastric Cancer in 4,505 Consecutive Patients

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.

Keywords: Gastrectomy; Postoperative complications; Stomach neoplasms.

Fig. 1. Proportion of patients achieving textbook outcome and each quality metric after delta-shaped anastomosis. Textbook outcomes: 81.7% for phase 1 (orange), 85.0% for phase 2 (green), and 82.3% for phase 3 (blue).

LN = lymph node; CDC = Clavien–Dindo classification; ICU = intensive care unit.

Fig. 2. Survival outcomes in patients who received minimally invasive distal gastrectomy with delta-shaped anastomosis.

(A) OS (all stages), (B) DFS (all stages), (C) OS based on whether TO was achieved (stages II and III), and (D) DFS based on whether TO was achieved (stages II and III). OS = overall survival; DFS = disease-free survival; TO = textbook outcome.