Department of Surgery, Hospital General Universitario Dr. Balmis, Avenida Pintor Baeza, 11, 03010, Alicante, Spain.
ISABIAL, Alicante, Spain.
World J Surg Oncol. 2023 Sep 12;21(1):288. doi: 10.1186/s12957-023-03166-8.
Textbook outcome (TO) is a multidimensional measure used to assess the quality of surgical practice. It is a reflection of an "ideal" surgical result, based on a series of benchmarks or established reference points that may vary depending on the pathology in question. References to TO in the literature are scarce, and the few reports that are available were all published very recently. In the case of gastric surgery, there is no established consensus on the parameters that should be included in TO, a circumstance that prevents comparison between series.
To present a review of the literature on TO in gastric surgery (TOGS) and to try to establish a consensus on its definition.
Following the PRISMA guide, we performed an unlimited search for articles on TOGS in the MEDLINE (PubMed), EMBASE and Cochrane, Latindex, Scielo, and Koreamed databases, without language restriction, updated on December 31, 2022. The inclusion criterion was any type of study assessing TO in adult patients after oncological gastric surgery. Selected studies were assessed, and TOGS was measured. The parameters used to assess the achievement of TOGS in selected studies were also recorded.
Twelve articles were included, comprising a total of 44,581 patients who had undergone an oncological gastric resection. The median rate of TOGS was 38.6%. All the publications but one included mortality as a TO variable, showing statistically significant differences in favor of the group in which TOGS was achieved. All articles included the number of nodes examined in the surgical specimen, with the assessment of fewer than 15 being associated with a low rate of TOGS achievement in five studies (41.7%). The variable postoperative complications according to the Clavien-Dindo score was the most important cause of failure to achieve TOGS in four studies (33.3%). Seven articles (58.3%) found a significant increase in long-term survival in patients who obtained TO. Advanced age, elevated ASA, and Charlson score had a negative impact on obtaining TOGS.
The standardization of TOGS is necessary to be able to establish comparable results between groups.
教科书结果（TO）是一种多维测量方法，用于评估外科实践的质量。它反映了一种“理想”的手术结果，基于一系列基准或既定的参考点，这些参考点可能因所涉及的病理学而异。文献中关于 TO 的参考文献很少，而且现有的少数报告都是最近才发表的。在胃外科手术中，关于 TO 应包含哪些参数尚未达成共识，这使得各系列之间无法进行比较。
综述胃外科手术中的教科书结果（TOGS）文献，并尝试就其定义达成共识。
根据 PRISMA 指南，我们在 MEDLINE（PubMed）、EMBASE 和 Cochrane、Latindex、Scielo 和 Koreamed 数据库中对 TOGS 的文献进行了无限制搜索，不限制语言，更新时间为 2022 年 12 月 31 日。纳入标准是评估成人接受肿瘤胃手术后 TOGS 的任何类型的研究。评估了所选研究，并测量了 TOGS。还记录了所选研究中用于评估 TOGS 达成情况的参数。
共纳入 12 篇文章，总计 44581 例接受肿瘤胃切除术的患者。TOGS 的中位率为 38.6%。除了一篇文章之外，所有出版物都将死亡率作为 TO 的一个变量，结果显示在达成 TOGS 的组中存在统计学显著差异。所有文章都包括在手术标本中检查的淋巴结数量，在五项研究中，评估少于 15 个淋巴结与 TOGS 达成率低有关（41.7%）。根据 Clavien-Dindo 评分的术后并发症变量是四项研究（33.3%）中导致无法达成 TOGS 的最重要原因。七篇文章（58.3%）发现获得 TO 的患者长期生存率显著提高。高龄、升高的 ASA 和 Charlson 评分对获得 TOGS 有负面影响。
需要对 TOGS 进行标准化，以便能够在组之间建立可比的结果。
