Textbook Oncological Outcome in European Gastrodata

Objective: To assess the rate of textbook outcome (TO) and textbook oncological outcome (TOO) in European population based on Gastrodata registry. Background: TO is a composite parameter assessing surgical quality and strongly correlates with improved overall survival. Following the standard of treatment for locally advanced gastric cancer (GC), TOO was proposed as a quality and optimal multimodal treatment parameter. Methods: TO was achieved when all the following criteria were met: no intraoperative complications, radical resection according to the surgeon, pR0 resection, retrieval of at least 15 lymph nodes, no severe postoperative complications, no reintervention, no admission to the intensive care unit, no prolonged length of stay, no postoperative mortality and no hospital readmission. TOO was defined as TO with addition of perioperative chemotherapy compliance. Results: From the 2558 patients, 1700 were included in the analysis. TO was achieved in 1164 (68.5%) patients. The use of neoadjuvant chemotherapy (OR=1.33, 95%CI: 1.04-1.70) and D2 or D2+ lymphadenectomy (OR=1.55, 95%CI: 1.15-2.10) had a positive impact on TO achievement. Older age (OR=0.73, 95%CI: 0.54-0.94), pT3/4 (OR=0.79, 95%CI: 0.63-0.99), ASA 3/4 (OR=0.68, 95%CI: 0.54-0.86) and total gastrectomy (OR=0.56, 95%CI: 0.45-0.70), had negative impact on TO achievement. TOO was achieved in 388 (22.8%) patients. Older age (OR=0.37, 95%CI: 0.27-0.53), pT3-pT4 (OR=0.52, 95%CI: 0.39-0.69) and ASA 3-4 (OR=0.58, 95%CI: 95%CI: 0.43-0.79) had negative impact on TOO achievement. Conclusion: Despite successively improved surgical outcomes, stage-appropriate chemotherapy in adherence to the current guidelines for multimodal treatment of GC remains poor. Further implementation of oncologic quality metrics should include greater emphasis on perioperative chemotherapy and adequate lymphadenectomy.