12 Textbook Outcomes After Esophagectomy in a Regional Australian Hospital: A Retrospective Observational Cohort Study

Abstract Introduction Textbook outcome is a composite tool to assess the quality of cancer care within an institution by evaluating several perioperative factors. Most studies assessing textbook outcomes after esophagectomy have been conducted in high-volume centres, achieving rates of up to 50%. To the best of our knowledge this is the first study to assess textbook outcomes after esophagectomy in a regional Australian hospital, providing a unique insight into the performance of this procedure in a country that has not widely adopted centralization of cases. Method A retrospective observational study was performed on patients that underwent esophagectomy at a single regional centre in Tasmania between January 2014 and December 2023. Textbook outcome was achieved when 10 criteria were met. The number of patients achieving each parameter was calculated, and several patients (age, gender, BMI, ASA), tumour (histology, T and N stage), and treatment (neoadjuvant therapy, surgical approach)-related parameters were assessed. Overall survival was also assessed. Results Sixty-five patients were identified. The overall textbook outcome rate was 32.3%. The most achieved parameters were R0 resection (100%) and no intraoperative complication (98.5%). The factors achieved least frequently were >15 lymph nodes (53.8%) and no reintervention (64.5%). A significant association was found between preoperative nodal stage and textbook outcome (P = 0.02). There was no difference in survival between patients with and without textbook outcomes. Conclusions Achieving higher rates of textbook outcomes remains a challenge, especially in the regional setting where access to services associated with higher rates of textbook outcomes may be limited.