Surgery by a minimally invasive approach is associated with improved textbook outcomes in oesophageal and gastric cancer

• Published in: European journal of surgical oncology 2021-09, Vol.47 (9), p.2332-2339
• Main Authors: Bolger, Jarlath C., Al Azzawi, Mohammed, Whooley, Jack, Bolger, Eamonn M., Trench, Luke, Allen, Jack, Kelly, Michael E., Brosnan, Conor, Arumugasamy, Mayilone, Robb, William B.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Esophageal Neoplasms - pathology; Esophageal Neoplasms - surgery; Esophageal Neoplasms - therapy; Esophagectomy - adverse effects; Esophagectomy - methods; Female; Gastrectomy - adverse effects; Gastrectomy - methods; Gastric cancer; Humans; Male; Margins of Excision; Middle Aged; Minimally invasive surgery; Minimally Invasive Surgical Procedures - adverse effects; Neoadjuvant Therapy; Neoplasm, Residual; Oesophageal cancer; Postoperative Complications - etiology; Proportional Hazards Models; Retrospective Studies; Stomach Neoplasms - pathology; Stomach Neoplasms - surgery; Stomach Neoplasms - therapy; Survival Rate; Textbook outcome; Treatment Outcome
• ISSN: 0748-7983; 1532-2157
• DOI: 10.1016/j.ejso.2021.03.240

Textbook outcome (TBO) is a composite measure of a number of peri-operative and clinical outcomes in oesophagogastric malignancy. It has previously been shown that TBOs are associated with improved overall survival in both oesophageal and gastric cancer. The influence of a minimally invasive approach (MIA) on TBO is not well defined. The purpose of this study is to validate TBO in our population, examine the influence of a MIA on achieving a TBO, and the impact of TBO on long-term survival. 269 patients undergoing oesophagectomy and 258 patients undergoing subtotal or total gastrectomy were included in this study. Demographic, clinical and pathological differences between patients with and without a TBO were compared using univariable and multivariable analysis. Overall survival for those with and without a TBO was examined. The influence of MIA on overall survival and TBO was determined using Cox proportional hazard models. Patients undergoing oesophagectomy and gastrectomy were significantly more likely to achieve a TBO when MIA was used (p = 0.01 and 0.001 respectively). When MIA is included as an outcome measure patients achieving a TBO show improved overall survival in both oesophageal and gastric cancer. MIA, clear resection margins and no unplanned admission to critical care are the strongest predictors of overall survival from the putative bundle of TBO parameters. Minimally invasive surgery is associated with improved TBO. Completion of a minimally invasive approach should be considered for inclusion as a textbook parameter.