Spolverato Gaya, Paro Alessandro, Capelli Giulia, Dalmacy Djhenne, Poultsides George A, Fields Ryan C, Weber Sharon M, Votanopoulos Konstantinos I, He Jin, Maithel Shishir K, Pucciarelli Salvatore, Pawlik Timothy M
Department of Surgical Oncological and Gastrointestinal Science, University of Padova, Padova, Italy.
Department of Surgery, The Ohio State Wexner Medical Center, Columbus, Ohio, USA.
J Surg Oncol. 2022 Mar;125(4):621-630. doi: 10.1002/jso.26778. Epub 2021 Dec 29.
Composite measures are increasingly used to assess quality of care in surgical oncology. We sought to define the incidence of "textbook oncologic outcome" (TOO) following resection of gastric adenocarcinoma among a large, international cohort of patients.
Gastric adenocarcinoma patients undergoing resection between 2000 and 2020 were identified from an international database. TOO was defined as margin-negative resection, examination of ≥16 lymph nodes, no prolonged length-of-stay (LOS), no 30-day mortality, and stage-appropriate receipt of chemotherapy.
Among a total of 910 patients, 321 patients (35.3%) achieved a postoperative TOO. While failure to evaluate ≥16 lymph nodes (n = 591, 65.0%) and receipt of chemotherapy (n = 651, 71.5%) had the greatest negative impact on the ability to obtain a TOO, no 30-day mortality (n = 880, 96.7%), margin-negative resection (n = 831, 91.3%), and no extended LOS (n = 706, 77.6%) were more commonly achieved. No postoperative complications (OR: 0.44; 95% CI: 0.31-0.63) and T1a/T1b-stage disease (OR: 2.87; 95% CI: 1.59-5.18) were independently associated with achieving a TOO (p < 0.05). The odds of achieving a TOO improved over time (p-trend < 0.05), which was largely attributable to improved odds of evaluating ≥16 lymph nodes (2010-2014 vs. 2000-2004: OR, 5.21; 95% CI: 3.22-8.45).
Only about one in three patients achieved a TOO following resection of gastric adenocarcinoma. Odds of TOO increased over time, largely due to improved lymph node evaluation.
综合指标越来越多地用于评估外科肿瘤学的医疗质量。我们试图在一个大型国际患者队列中确定胃腺癌切除术后“教科书式肿瘤学结局”（TOO）的发生率。
从一个国际数据库中识别出2000年至2020年间接受胃腺癌切除术的患者。TOO定义为切缘阴性切除、检查≥16枚淋巴结、无住院时间延长（LOS）、无30天死亡率以及按分期适当接受化疗。
在总共910例患者中，321例患者（35.3%）术后达到TOO。虽然未检查≥16枚淋巴结（n = 591，65.0%）和接受化疗（n = 651，71.5%）对获得TOO的能力有最大的负面影响，但无30天死亡率（n = 880，96.7%）、切缘阴性切除（n = 831，91.3%）和无住院时间延长（n = 706，77.6%）更为常见。无术后并发症（OR：0.44；95% CI：0.31 - 0.63）和T1a/T1b期疾病（OR：2.87；95% CI：1.59 - 5.18）与达到TOO独立相关（p < 0.05）。获得TOO的几率随时间提高（p趋势 < 0.05），这在很大程度上归因于检查≥16枚淋巴结几率的提高（2010 - 2014年与2000 - 2004年相比：OR，5.21；95% CI：3.22 - 8.45）。
胃腺癌切除术后只有约三分之一的患者达到TOO。TOO的几率随时间增加，主要是由于淋巴结评估的改善。
