MS O07 - OGC ‘Textbook Outcome’ for Gastrectomy: Redefining a Valid Composite Measure Assessment Tool for Surgical Performance in a Specialist Unit within the United Kingdom

Abstract Background A ten-item composite measure defining ‘textbook outcome’ (TBO) following oesophagogastric cancer surgery was proposed to benchmark surgical quality. While subsequent studies have demonstrated an association between TBO and improved survival, the reported proportion of patients who meet all the required criteria remained consistently low. Postoperative complications of Clavien-Dindo grade ≥2 (CD≥2) commonly preclude TBO, despite evidence that minor complications are unlikely to influence long-term outcomes. This study aimed to assess whether modification of TBO parameters to Clavien-Dindo grade ≥3 (CD≥3) is associated with improved overall survival in patients undergoing gastric cancer surgery within an UK specialist unit. Method Consecutive patients who underwent a surgical resection for gastric cancer, at a single tertiary centre between January 2016 and December 2019, were identified from a prospectively maintained regional database. Patients were included irrespective of (neo)adjuvant treatments. Data collected included clinicopathological characteristics, treatment modalities and postoperative outcomes. Comparisons were drawn between patients who met all the parameters defining TBO and those who did not, using both CD≥2 and CD≥3 classifications for ‘major’ complications. The primary outcome of interest was overall survival. Results Sixty-seven patients (median 70 years, 61.2% male) underwent resection for gastric cancer during this study. Of these, 27 patients (40.3%) achieved TBO based on a CD≥2 complication grading and 38 patients (56.7%) when CD≥3 was used. Clinicopathological characteristics were all comparable between TBO groups based on both cut-offs. Improved overall survival was evident with a CD≥3 TBO (p=0.026), however not with CD≥2 TBO (p=0.430). Following adjustment for confounding variables, CD≥3 TBO remained associated with improved overall survival (HR: 0.30 (95% CI: 0.10-0.93), p=0.037) while CD≥2 TBO was not (HR: 0.64 (95% CI: 0.21-1.93), p=0.428). Conclusion Textbook outcome is a multi-parameter metric for benchmarking quality in gastric cancer surgery. Modification of the complications parameter required for TBO to CD≥3 in our patient population resulted in a stronger association with overall survival amongst patients undergoing surgical resection for gastric cancer.