Textbook outcomes in the liver-first approach for colorectal liver metastases: prospective multicentre analysis
Authors: Ramia José M , Villodre-Tudela Celia , Falgueras-Verdaguer Laia , Zambudio-Carroll Natalia , Castell-Gómez José T , Carbonell-Morote Silvia , Blas-Laina Juan L , Borrego-Estella Vicente , Sánchez-Pérez Belinda , Serradilla-Martín Mario ,   RENACI Project Collaborative Study Group, Domingo-del-Pozo Carlos , García-Plaza Gabriel , González-Rodríguez Francisco J , Montalvá-Orón Eva M , Moya-Herraiz Ángel , Paterna-López Sandra , Suárez-Muñoz Miguel A , Alkorta-Zuloaga Maialen , Blanco-Fernández Gerardo , Dabán-Collado Enrique , Gómez-Bravo Miguel A , Miota-de-Llamas José I , Rotellar Fernando , Sánchez-Cabús Santiago , Pacheco-Sánchez David , Rodríguez-Sanjuán Juan C , Varona-Bosque María A , Carrión-Álvarez Lucía , de la Serna-Esteban Sofía , Dopazo-Taboada Cristina , Martín-Pérez Elena , Martínez-Cecilia David , Castro-Santiago María J , Dorcaratto Dimitri , Gutiérrez-Díaz Marta L , Asencio-Pascual José M , Burdío-Pinilla Fernando , Carracedo-Iglesias Roberto , Escartín-Arias Alfredo , Ielpo Benedetto , Rodríguez-Laiz Gonzalo , Valdivieso-López Andrés , De-Vicente-López Emilio , Alonso-Orduña Vicente 
Published: January 2024

Abstract

Background
Textbook outcome is a valuable tool for assessing surgical outcomes. The aim of this study was to analyse textbook-outcome rates in the prospective Spanish National Registry of the Liver-First Approach (RENACI Project) and the factors influencing textbook-outcome achievement. Additionally, a model for assessing a procedure-specific textbook outcome for the liver-first approach was proposed.

Methods
A retrospective analysis of a prospective and multicentre database that included consecutive patients with colorectal cancers and synchronous liver metastases who underwent a liver-first approach between June 2019 and August 2020 was performed. Two types of textbook outcome were measured: classic textbook outcome and liver-first-approach-specific textbook outcome (which included negative margins, no perioperative transfusion, no postoperative major surgical complications, no prolonged length of hospital stay, no readmissions, no mortality, and full treatment completion). The primary endpoint was textbook-outcome rate for a liver-first approach at 90 days.

Results
A total of 149 patients were included in the analysis. Classic and liver-first-approach-specific textbook-outcome rates were 71.8 per cent (107 patients) and 46 per cent (69 patients) respectively. Factors significantly associated with liver-first-approach-specific textbook-outcome achievement in the multivariable analysis were the number of metastases (OR 0.82 (95 per cent c.i. 0.73 to 0.92); P = 0.001) and intraoperative blood loss (OR 0.99 (95 per cent c.i. 0.99 to 1.00); P = 0.007). Prolonged length of hospital stay (33 patients, 41 per cent), positive margins (31 patients, 39 per cent), perioperative transfusion (27 patients, 34 per cent), and no full treatment completion (18 patients, 23 per cent) were the items that most frequently prevented liver-first-approach-specific textbook-outcome achievement.

Conclusion
Liver-first-approach-specific textbook outcome is a promising tool for measuring the quality of care when using the liver-first approach for synchronous colorectal liver metastases.