Department of Surgery, Loyola University Medical Center, Maywood, IL, USA.
Department of Surgery, The Ohio State University Wexner Medical Center, 395 W 12th Ave Ste 670, Columbus, OH, 43210, USA.
J Gastrointest Surg. 2021 Mar;25(3):775-785. doi: 10.1007/s11605-020-04767-4. Epub 2020 Aug 10.
Traditional metrics may inadequately represent rates of attaining optimal oncologic care. We evaluated a composite "textbook oncologic outcome" (TOO) to assess the incidence of achieving an "optimal" clinical result after colon adenocarcinoma (CA) resection.
The National Cancer Database (NCDB) was queried to identify patients undergoing colectomy for non-metastatic CA between 2010 and 2015. TOO was defined as a margin negative resection with an AJCC compliant lymph node evaluation, no prolonged length of stay (LOS) or 30-day readmission/mortality, as well as receipt of stage appropriate adjuvant chemotherapy.
Among 170,120 patients who underwent colectomy at 1315 hospitals, 93,204 (54.8%) achieved TOO with large variations observed among facilities. While certain factors were achieved nearly universally (R0 margin, 95.6%; no 30-day mortality, 97.2%), avoidance of prolonged LOS (77.3%) and appropriate adjuvant chemotherapy (83.0%) were achieved less consistently. On multivariable analysis, Black race/ethnicity (OR 0.82, 95% CI 0.80-0.85), Medicaid insurance (OR 0.64, 0.61-0.68), and low-volume facility (< 50/year) (OR 0.83, 0.77-0.89) were associated with decreased likelihood of TOO. Achievement of TOO was associated with improved long-term survival (HR 0.45; 95% CI 0.44-0.46).
Roughly one-half of patients undergoing resection of CA achieved an optimal clinical outcome. TOO may be a more useful quality metric to assess patient-centric composite outcomes following surgical procedures.
传统指标可能无法充分反映获得最佳肿瘤治疗效果的比例。我们评估了一种综合的“教科书式肿瘤学结果”（TOO），以评估在结肠腺癌（CA）切除术后达到“最佳”临床结果的发生率。
国家癌症数据库（NCDB）被查询以确定 2010 年至 2015 年期间接受非转移性 CA colectomy 的患者。TOO 被定义为边缘阴性的切除术，具有 AJCC 符合的淋巴结评估，没有延长的住院时间（LOS）或 30 天再入院/死亡率，以及接受适当的辅助化疗。
在 1315 家医院接受 colectomy 的 170120 名患者中，93204 名（54.8%）达到了 TOO，各个机构之间存在很大差异。虽然某些因素几乎普遍实现（R0 边缘，95.6%；30 天内无死亡率，97.2%），但避免延长 LOS（77.3%）和适当的辅助化疗（83.0%）的实现则不那么一致。在多变量分析中，黑人种族/民族（OR 0.82，95%CI 0.80-0.85）、医疗补助保险（OR 0.64，0.61-0.68）和低容量设施（<50/年）（OR 0.83，0.77-0.89）与 TOO 发生的可能性降低相关。达到 TOO 与长期生存改善相关（HR 0.45；95%CI 0.44-0.46）。
大约一半接受 CA 切除术的患者达到了最佳临床结果。TOO 可能是评估手术后以患者为中心的综合结果的更有用的质量指标。
