Textbook Outcome in rectal cancer surgery

Abstract

Background: Textbook outcome (TO) is a composite measure of perioperative indicators used to assess healthcare quality in surgery. Its specific use in rectal cancer surgery remains limited, and there is no international consensus on its definition.
Objective: The aim of this study was to determine the rate of TO achievement in patients undergoing rectal cancer surgery and to analyze the variables associated with TO achievement.
Material and methods: We conducted a retrospective observational study that included consecutive patients who underwent elective rectal cancer surgery between January 2022 and December 2023. Textbook outcome was defined following the criteria of Wraps et al. as the simultaneous achievement of R0 resection, absence of major postoperative complications (Clavien-Dindo grade ≥ III), length of hospital stay <14 days, no readmission within 30 days, and no 90-day mortality. Descriptive, univariate, and multivariate logistic regression analyses were performed to identify factors associated with TO achievement.
Results: Of the 59 patients included in the study, 38 (64.4%) achieved the TO. A prolonged length of hospital stay was the most common factor preventing TO achievement, followed by major postoperative complications. readmissions and no R0 resections. Textbook Outcome achievement was associated with a lower Comprehensive Complication Index (CCI) score, lower requirement for parenteral nutrition, and a lower rate of ostomy creation.
Conclusions: The findings reported in this study are comparable to, and in some respects even better than, those previously published. However, they should be interpreted carefully because of the small sample size. International standardization of the TO definition through expert consensus would enhance its applicability and facilitate comparisons across centers.