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Comparative Study
. 2025 Feb 1;23(1):32.
doi: 10.1186/s12957-025-03686-5.

Textbook outcome in ovarian cancer and its impact on survival: comparative study

Silvia Carbonell-Morote #  1   2 , Alvaro Arjona-Sánchez #  3 , Pedro Antonio Cascales-Campos  4   5 , Alida González-Gil  6 , Gonzalo Gomez-Dueñas  3 , Elena Gil-Gómez  6 , Iban Caravaca-García  7 , Veronica Aranaz  7 , Francisco Javier Lacueva #  1   7 , José Manuel Ramia #  1   2
Affiliations
Comparative Study

Textbook outcome in ovarian cancer and its impact on survival: comparative study

Silvia Carbonell-Morote et al. World J Surg Oncol. .

Abstract

Introduction: Patients who achieve the textbook outcome (TO) present an uneventful postoperative course. Obtaining TO has also been related to better survival in oncological patients. Information about TO in patients with peritoneal carcinomatosis from ovarian cancer who undergo surgery is very scarce. Our objective was investigate TO in patients with carcinomatosis of ovarian origin who underwent interval surgery with or without HIPEC (TOOC) and its impact on survival.

Methods: A multicenter study was performed between 2010 and 2015. Inclusion criteria were > 18 years old, with ovarian cancer and peritoneal carcinomatosis, who underwent scheduled surgery after response to neoadjuvant therapy. The criteria to establish TOOC were no major complications, no mortality, non-prolonged stay (p75:10 days), complete cytoreduction (CC-0), and no readmission.

Results: 365 patients were included, and TOOC was achieved in 204 (55.9%) patients. CC-0 cytoreduction was obtained in 312(85.5%). 7 patients (1.9%) died. 71 (19.5%) presented major complications (≥ IIIa). The readmission rate was 9.3%, and 24.9% of the patients presented a prolonged stay. The parameter with most significant negative impact on achieving TOOC was length of stay. Multivariate analysis confirmed postsurgical PCI, age, HIPEC, and time of surgery in minutes as an independent factor of TOOC. Survival analysis showed that patients who achieved TOOC had better overall survival (41 months (24.5- 67) versus 27 months (14-48.2) (p < 0.0001).

Conclusion: TO is an easy and valuable management tool for evaluating and comparing results obtained at different centers after surgery for peritoneal carcinomatosis of locally advanced ovarian cancer. Achieving TOOC benefits overall survival.

Keywords: Benchmarking; Carcinomatosis; HIPEC; Ovarian cancer; Textbook outcome.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Study approved Ethics Committee of Hospital General Universitario Dr. Balmis (Ref. CEIm: PI2023-070). The study followed the guidelines for Strenghtening the Reporting of Observational Studies in Epidemiology (STROBE). The study is registered in www.researchregistry.com/with the unique identification number (UIN) 10,306. The medical ethics committee judged that no informed consent from the patients was necessary because of the observational nature of the study without additional burden for the patient. Including the waiver of informed consent and consent for participate due the retrospective nature of the study, entailed no risk. (Page 7). Consent for publication: Not applicable. Waived for ethics Committee (Page 7). Provenance and peer review not commissioned, externally peer-reviewed. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Textbook outcome in ovarian carcinomatosis. (TOOC)
Fig. 2
Fig. 2
Kalpan- Maier curve for textbook outcome in Ovarian Carcinomatosis (TOOC)
See this image and copyright information in PMC

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