• Katarzyna Sędłak, Karol Rawicz-Pruszyński, Radosław Mlak, Johanna Van Sandick, Suzanne Gisbertz, Manuel Pera, Dal CeroMariagiuliaMDepartment of Digestive Surgery, Hospital Universitario del Mar, Barcelona, Spain., Gian Luca Baiocchi, Andrea Celotti, Paolo Morgagni, Giovani Vittimberga, Arnulf Hoelscher, Stefan Moenig, Piotr Kołodziejczyk, Piotr Richter, Ines Gockel, Guillaume Piessen, Paulo Matos Da Costa, Andrew Davies, Cara Baker, William Allum, RomarioUberto FumagalliUFDigestive Surgery, European Institute of Oncology, IRCCS, Milan, Italy., Stefano De Pascale, Ricccardo Rosati, Daniel Reim, Lucio Lara Santos, Domenico D'ugo, Bas Wijnhoven, Maurizio Degiuli, Giovanni De Manzoni, Wojciech Kielan, Ewelina Frejlich, Paul Schneider, and Wojciech P Polkowski.
• Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland.
• Ann. Surg. 2023 Nov 1; 278 (5): 823831823-831.

ObjectiveTo assess the rate of textbook outcome (TO) and textbook oncological outcome (TOO) in the European population based on the GASTRODATA registry.BackgroundTO is a composite parameter assessing surgical quality and strongly correlates with improved overall survival. Following the standard of treatment for locally advanced gastric cancer, TOO was proposed as a quality and optimal multimodal treatment parameter.MethodsTO 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 the addition of perioperative chemotherapy compliance.ResultsOf the 2558 patients, 1700 were included in the analysis. TO was achieved in 1164 (68.5%) patients. The use of neoadjuvant chemotherapy [odds ratio (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 a 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 or pT4 (OR = 0.52, 95% CI: 0.39-0.69), and ASA 3 or 4 (OR = 0.58, 95% CI: 0.43-0.79) had a negative impact on TOO achievement.ConclusionsDespite successively improved surgical outcomes, stage-appropriate chemotherapy in adherence to the current guidelines for multimodal treatment of gastric cancer remains poor. Further implementation of oncologic quality metrics should include greater emphasis on perioperative chemotherapy and adequate lymphadenectomy.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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