Çetinkaya-Hosgör Candan, Seika Philippa, Raakow Jonas, Kröll Dino, Dobrindt Eva Maria, Maurer Max Magnus, Martin Friederike, Ossami Saidy Ramin Raul, Thuss-Patience Peter, Pratschke Johann, Biebl Matthias, Denecke Christian
Chirurgische Klinik, Campus Charité Mitte, Campus Virchow-Klinikum, Charité Universitätsmedizin, 10117 Berlin, Germany.
Department of Surgery, Division of Surgical Sciences, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
J Clin Med. 2023 Aug 21;12(16):5419. doi: 10.3390/jcm12165419.
(1) Background: The complexity of the perioperative outcome for patients with gastric cancer is not well reflected by single quality metrics. To study the effect of the surgical outcome on survival, we have evaluated the relationship between textbook outcome (TO)-a new composite parameter-and oncological outcome. (2) Methods: All patients undergoing total gastrectomy or trans-hiatal extended gastrectomy for gastric cancer with curative intent between 2017 and 2021 at our institution were included. TO was defined by negative resection margins (R0); collection of ≥25 lymph nodes; the absence of major perioperative complications (Clavien-Dindo ≥ 3); the absence of any reintervention; absence of unplanned ICU re-admission; length of hospital stay < 21 days; absence of 30-day readmission and 30-day mortality. We evaluated factors affecting TO by multivariate logistic regression. The correlation between TO and long-term survival was assessed using a multivariate cox proportional-hazards model. (3) Results: Of the patients included in this study, 52 (52.5 %) achieved all TO metrics. Open surgery ( = 0.010; OR 3.715, CI 1.334-10.351) and incomplete neoadjuvant chemotherapy ( = 0.020, OR 4.278, CI 1.176-15.553) were associated with failure to achieve TO on multivariate analysis. The achievement of TO significantly affected overall survival ( = 0.015). TO ( = 0.037, OD 0.448, CI 0.211-0.954) and CCI > 4 ( = 0.034, OR 2.844, CI 1.079-7.493) were significant factors affecting DFS upon univariate analysis. In multivariate analysis, CCI > 4 ( = 0.035, OR 2.605, CI 0.983-6.905) was significantly associated with DFS. (4) Conclusions: We identified patient- and procedure-related factors influencing TO. Importantly, achieving TO is strongly associated with improved long-term survival in gastric cancer patients and merits further focus on surgical quality improvement efforts.
(1) 背景：单一质量指标不能很好地反映胃癌患者围手术期结果的复杂性。为研究手术结果对生存的影响，我们评估了教科书式结果（TO）——一个新的综合参数——与肿瘤学结果之间的关系。(2) 方法：纳入2017年至2021年在我院接受根治性全胃切除术或经裂孔扩大胃切除术的所有胃癌患者。TO的定义为切缘阴性（R0）；收集≥25枚淋巴结；无重大围手术期并发症（Clavien-Dindo≥3级）；无任何再次干预；无计划外重症监护病房再入院；住院时间<21天；无30天再入院和30天死亡率。我们通过多因素逻辑回归评估影响TO的因素。使用多因素Cox比例风险模型评估TO与长期生存之间的相关性。(3) 结果：本研究纳入的患者中，52例（52.5%）达到了所有TO指标。开放手术（P = 0.010；OR 3.715，CI 1.334 - 10.351）和新辅助化疗不完整（P = 0.020，OR 4.278，CI 1.176 - 15.553）在多因素分析中与未达到TO相关。达到TO显著影响总生存（P = 0.015）。单因素分析时，TO（P = 0.037，OD 0.448，CI 0.211 - 0.954）和CCI>4（P = 0.034，OR 2.844，CI 1.079 - 7.493）是影响无病生存的显著因素。多因素分析中，CCI>4（P = 0.035，OR 2.605，CI 0.983 - 6.905）与无病生存显著相关。(4) 结论：我们确定了影响TO的患者和手术相关因素。重要的是，达到TO与胃癌患者长期生存改善密切相关，值得进一步关注手术质量改进工作。
