Akash Premkumar, BS
Harvard Medical School Student
Akash Premkumar BS, Emanuele Mazzola PhD, Jon O Wee MD, Yu Xie BS, Dan Lee BS, Ashley Deeb MD, Emily Polhemus BS, Michael Jaklitsch MD, Ciaran McNamee MD, Steven Mentzer MD, Abby White DO, Hasan Khalil MD, Raphael Bueno MD, Scott J Swanson MD
Scott J Swanson MD
Research Category: Cancer
Introduction: We validate textbook outcome (TO)—a composite quality metric in cancer care—in esophageal cancer by determining its association with survival and the relative contributions of individual variables in textbook outcome.
Methods: An institutional database was used to identify patients who underwent potentially curative esophagectomy for esophageal cancer from 2005 – 2020. TO was defined as R0 resection, assessment of ≥16 lymph nodes, no severe postoperative complications, non-outlier length of stay, completion of all intended multimodal therapy, and no ICU readmission, reintervention, and 30-day readmission.
Results: Of 1135 patients, 34.2% achieved a TO. Pathologic assessment of ≥16 lymph nodes (71.3%) and R0 resection (96.6%) were the least and most satisfied criteria, respectively. The median OS of the TO-group (100.7 [80.3 – NA] months) was longer than that of the non-TO group (45.8 [37.6 – 55.6] months; p<0.001). After adjustment, TO was independently associated with improved OS (HR: 0.65 [0.54 – 0.80], p<0.001). R0 resection and no severe postoperative complications were the two most important variables in calculating TO.
Conclusions: Achieving a textbook oncologic outcome is associated with improved long-term survival after esophagectomy. The two most important TO variables are R0 resection and absence of severe postoperative complications. Providers should focus on preventing severe postoperative complications to increase the rate of achieving TO.
Introduction: There is an overwhelming number of quality metrics in cancer care that patients can use to evaluate surgeons and hospitals. Here, we validate textbook outcome (TO)—a novel, holistic, and composite quality metric—in esophageal cancer care.
Methods: An institutional database was used to identify patients who underwent esophagectomy for esophageal cancer from 2005 – 2020. A patient was determined have a textbook outcome if they experienced complete tumor removal, underwent adequate lymph node assessment, experienced no severe postoperative complications and a reasonable length of stay, completed all intended chemotherapy and radiation therapy, and did not experience ICU readmission, reintervention, and 30-day readmission.
Results: Of 1135 patients, 34.2% achieved a textbook outcome. The assessment of lymph nodes and complete tumor removal were the least and most satisfied criteria, respectively. Patients who experienced textbook outcome had a median survival (100.7 months) which was significantly longer than that of patients who did not experience textbook outcome (45.8 months). Textbook outcome reduces the risk of mortality by 35%. The two most important criteria in textbook outcome are complete tumor removal and the absence of severe postoperative complications.
Conclusions: Experiencing a textbook outcome is associated with improved long-term survival after esophagectomy. Patients and providers can use textbook outcome as a valid quality measure when evaluating surgical care in patients with esophageal cancer.