Riadh Salem, Lorenzo Giorgi, Wing K Chou, Sheraz R Markar
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Reviewers screened studies and extracted data on characteristics, definitions, achievement rates, and survival outcomes. Owing to heterogeneity, findings were summarised narratively.</p><p><strong>Results: </strong>Forty-five studies (published 2017-2025; n = 139,972 patients) were included. Definitions varied, with 26 unique components identified. Common components were adequate lymphadenectomy (≥ 15 nodes), absence of postoperative complications (Clavien-Dindo grade ≥ II), and no 30-day readmission. Median TO and TOO achievement rates were 58.6% (IQR: 37.6-75.8) and 30.3% (IQR: 23.6-40.2). The primary barriers were inadequate lymphadenectomy and CD ≥ II complications. Twelve studies reported a significant association between TO/TOO and improved overall and disease-free survival. Influencing factors included age, comorbidity, tumour characteristics, surgeon volume, and surgical approach. Limitations included non-standardised definitions, limited patient-reported outcomes, and a lack of prospective validation.</p><p><strong>Conclusion: </strong>TO and TOO are associated with improved survival in gastrectomy but are hampered by inconsistent definitions and limited prospective evidence. Standardisation, patient-reported outcomes, and prospective validation are needed to realise their potential as clinically useful quality metrics.</p>","PeriodicalId":12684,"journal":{"name":"Gastric Cancer","volume":" ","pages":""},"PeriodicalIF":5.1000,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Textbook outcome in gastrectomy: useful metric or moving target? 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引用次数: 0
摘要
背景：包括教科书预后（TO）和教科书肿瘤预后（TOO）在内的复合指标越来越多地用于评估胃癌手术研究的质量。然而，不一致和可变的报告限制了它们的临床应用。目的：本综述旨在分类胃切除术中to和TOO的定义和标准，报告成活率和决定因素，与生存结果的关系，并确定方法学上的差距。方法：检索MEDLINE、Embase、Web of Science、Scopus自建站至2025年4月的文献。符合条件的研究报告了接受癌症治疗意图胃切除术的成人的TO或TOO。审稿人筛选研究并提取有关特征、定义、成功率和生存结果的数据。由于异质性，研究结果以叙述方式总结。结果：纳入45项研究（2017-2025年发表；n = 139972例患者）。定义各不相同，确定了26种独特的成分。常见的组成部分是充分的淋巴结切除术（≥15个淋巴结），无术后并发症（Clavien-Dindo分级≥II），无30天再入院。TO和TOO的中位完成率分别为58.6% （IQR: 37.6-75.8）和30.3% （IQR: 23.6-40.2）。主要障碍是淋巴结切除术不充分和CD≥II并发症。12项研究报告了TO/TOO与改善的总生存率和无病生存率之间的显著关联。影响因素包括年龄、合并症、肿瘤特征、手术量和手术入路。局限性包括非标准化的定义，有限的患者报告的结果，以及缺乏前瞻性验证。结论：胃切除术中TO和TOO与生存率提高有关，但由于定义不一致和前瞻性证据有限而受到阻碍。标准化、患者报告的结果和前瞻性验证需要实现其作为临床有用质量指标的潜力。
Textbook outcome in gastrectomy: useful metric or moving target? A scoping review.
Background: Composite metrics including Textbook Outcome (TO) and Textbook Oncological Outcome (TOO) are increasingly utilised to assess quality in gastric cancer surgical research. However, inconsistent and variable reporting limits their clinical application.
Objective: This scoping review aimed to catalogue definitions and criteria of TO and TOO in gastrectomy, report achievement rates and determinants, associations with survival outcomes, and identify methodological gaps.
Methods: A search was conducted in MEDLINE, Embase, Web of Science, and Scopus from inception to April 2025. Eligible studies reported TO or TOO for adults undergoing curative-intent gastrectomy for cancer. Reviewers screened studies and extracted data on characteristics, definitions, achievement rates, and survival outcomes. Owing to heterogeneity, findings were summarised narratively.
Results: Forty-five studies (published 2017-2025; n = 139,972 patients) were included. Definitions varied, with 26 unique components identified. Common components were adequate lymphadenectomy (≥ 15 nodes), absence of postoperative complications (Clavien-Dindo grade ≥ II), and no 30-day readmission. Median TO and TOO achievement rates were 58.6% (IQR: 37.6-75.8) and 30.3% (IQR: 23.6-40.2). The primary barriers were inadequate lymphadenectomy and CD ≥ II complications. Twelve studies reported a significant association between TO/TOO and improved overall and disease-free survival. Influencing factors included age, comorbidity, tumour characteristics, surgeon volume, and surgical approach. Limitations included non-standardised definitions, limited patient-reported outcomes, and a lack of prospective validation.
Conclusion: TO and TOO are associated with improved survival in gastrectomy but are hampered by inconsistent definitions and limited prospective evidence. Standardisation, patient-reported outcomes, and prospective validation are needed to realise their potential as clinically useful quality metrics.
期刊介绍：
Gastric Cancer is an esteemed global forum that focuses on various aspects of gastric cancer research, treatment, and biology worldwide.
The journal promotes a diverse range of content, including original articles, case reports, short communications, and technical notes. It also welcomes Letters to the Editor discussing published articles or sharing viewpoints on gastric cancer topics.
Review articles are predominantly sought after by the Editor, ensuring comprehensive coverage of the field.
With a dedicated and knowledgeable editorial team, the journal is committed to providing exceptional support and ensuring high levels of author satisfaction. In fact, over 90% of published authors have expressed their intent to publish again in our esteemed journal.
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