Textbook outcome contributes to long-term prognosis in older adults with gastric cancer

Abstract

Abstract Purpose Textbook outcome (TO) is a composite quality measurement of short-term outcomes for evaluating surgical procedures. We investigated whether TO can be used to predict outcomes after curative gastric cancer (GC) surgery in older adults. Methods We retrospectively analyzed 465 consecutive patients who underwent curative gastrectomy for GC from 2005 to 2017. Among these, 141 advanced-age patients were eligible. The patients were divided into two groups: those who achieved TO (a-TO group) and those who failed to achieve TO (f-TO group). In accordance with previous reports, TO consisted of eight metrics. We evaluated the association between TO and long-term survival. Results TO was achieved 73 (52%) patients. The patients in the f-TO group had a significantly higher body mass index (P = 0.01), longer surgery time (P = 0.03), and more blood loss (P = 0.001). The metric with the lowest achievement rate was “no postoperative severe complication.” The patients in the f-TO group had significantly shorter overall survival than those in the a-TO group (P = 0.03). Multivariable Cox regression analyses of overall survival revealed that an American Society of Anesthesiologists physical status classification of 3 (hazard ratio [HR], 2.97; 95% confidence interval [CI], 1.68–5.26; P = 0.0002), presence of lymph node metastasis (HR, 1.86; 95% CI, 1.03–3.35; P = 0.04), and f-TO (HR, 1.82; 95% CI, 1.04–3.19; P = 0.03) were significantly associated with poor overall survival. Conclusion TO can be used to predict outcomes after curative GC surgery in patients of advanced age.