Textbook outcome following oesophagectomy for cancer: international cohort study
Authors:   Oesophago-Gastric Anastomotic Audit (OGAA) Collaborative, Kamarajah S K , Evans R P T , Nepogodiev D , Hodson J , Bundred J R , Gockel I , Gossage J A , Isik A , Kidane B , Mahendran H A , Negoi I , Okonta K E , Sayyed R , van Hillegersberg R , Vohra R S , Wijnhoven B P L , Singh P , Griffiths E A , Kamarajah S K , Hodson J , Griffiths E A , Alderson D , Bundred J , Evans R P T , Gossage J , Griffiths E A , Jefferies B , Kamarajah S K , McKay S , Mohamed I , Nepogodiev D , Siaw-Acheampong K , Singh P , van Hillegersberg R , Vohra R , Wanigasooriya K , Whitehouse T , Gjata A , Moreno J I , Takeda F R , Kidane B , Guevara Castro R , Harustiak T , Bekele A , Kechagias A , Gockel I , Kennedy A , Da Roit A , Bagajevas A , Azagra J S , Mahendran H A , Mejía-Fernández L , Wijnhoven B P L , El Kafsi J , Sayyed R H , Sousa M M , Sampaio A S , Negoi I , Blanco R , Wallner B , Schneider P M , Hsu P K , Isik A , Gananadha S , Wills V , Devadas M , Duong C , Talbot M , Hii M W , Jacobs R , Andreollo N A , Johnston B , Darling G , Isaza-Restrepo A , Rosero G , Arias-Amézquita F , Raptis D , Gaedcke J , Reim D , Izbicki J , Egberts J H , Dikinis S , Kjaer D W , Larsen M H , Achiam M P , Saarnio J , Theodorou D , Liakakos T , Korkolis D P , Robb W B , Collins C , Murphy T , Reynolds J , Tonini V , Migliore M , Bonavina L , Valmasoni M , Bardini R , Weindelmayer J , Terashima M , White R E , Alghunaim E , Elhadi M , Leon-Takahashi A M , Medina-Franco H , Lau P C , Okonta K E , Heisterkamp J , Rosman C , van Hillegersberg R , Beban G , Babor R , Gordon A , Rossaak J I , Pal K M I , Qureshi A U , Naqi S A , Syed A A , Barbosa J , Vicente C S , Leite J , Freire J , Casaca R , Costa R C T , Scurtu R R , Mogoanta S S , Bolca C , Constantinoiu S , Sekhniaidze D , Bjelović M , So J B Y , Gačevski G , Loureiro C , Pera M , Bianchi A , Moreno Gijón M , Martín Fernández J , Trugeda Carrera M S , Vallve-Bernal M , Cítores Pascual M A , Elmahi S , Halldestam I , Hedberg J , Mönig S , Gutknecht S , Tez M , Guner A , Tirnaksiz M B , Colak E , Sevinç B , Hindmarsh A , Khan I , Khoo D , Byrom R , Gokhale J , Wilkerson P , Jain P , Chan D , Robertson K , Iftikhar S , Skipworth R , Forshaw M , Higgs S , Gossage J , Nijjar R , Viswanath Y K S , Turner P , Dexter S , Boddy A , Allum W H , Oglesby S , Cheong E , Beardsmore D , Vohra R , Maynard N , Berrisford R , Mercer S , Puig S , Melhado R , Kelty C , Underwood T , Dawas K , Lewis W , Bryce G , Thomas M , Arndt A T , Palazzo F , Meguid R A , Fergusson J , Beenen E , Mosse C , Salim J , Cheah S , Wright T , Cerdeira M P , McQuillan P , Richardson M , Liem H , Spillane J , Yacob M , Albadawi F , Thorpe T , Dingle A , Cabalag C , Loi K , Fisher O M , Ward S , Read M , Johnson M , Bassari R , Bui H , Cecconello I , Sallum R A A , da Rocha J R M , Lopes L R , Tercioti Jr V , Coelho J D S , Ferrer J A P , Buduhan G , Tan L , Srinathan S , Shea P , Yeung J , Allison F , Carroll P , Vargas-Barato F , Gonzalez F , Ortega J , Nino-Torres L , Beltrán-García T C , Castilla L , Pineda M , Bastidas A , Gómez-Mayorga J , Cortés N , Cetares C , Caceres S , Duarte S , Pazdro A , Snajdauf M , Faltova H , Sevcikova M , Mortensen P B , Katballe N , Ingemann T , Morten B , Kruhlikava I , Ainswort A P , Stilling N M , Eckardt J , Holm J , Thorsteinsson M , Siemsen M , Brandt B , Nega B , Teferra E , Tizazu A , Kauppila J H , Koivukangas V , Meriläinen S , Gruetzmann R , Krautz C , Weber G , Golcher H , Emons G , Azizian A , Ebeling M , Niebisch S , Kreuser N , Albanese G , Hesse J , Volovnik L , Boecher U , Reeh M , Triantafyllou S , Schizas D , Michalinos A , Balli E , Mpoura M , Charalabopoulos A , Manatakis D K , Balalis D , Bolger J , Baban C , Mastrosimone A , McAnena O , Quinn A , Ó Súilleabháin C B , Hennessy M M , Ivanovski I , Khizer H , Ravi N , Donlon N , Cervellera M , Vaccari S , Bianchini S , Asti E , Bernardi D , Merigliano S , Provenzano L , Scarpa M , Saadeh L , Salmaso B , De Manzoni G , Giacopuzzi S , La Mendola R , De Pasqual C A , Tsubosa Y , Niihara M , Irino T , Makuuchi R , Ishii K K , Mwachiro M , Fekadu A , Odera A , Mwachiro E , AlShehab D , Ahmed H A , Shebani A O , Elhadi A , Elnagar F A , Elnagar H F , Makkai-Popa S T , Wong L F , Tan Y R , Thannimalai S , Ho C A , Pang W S , Tan J H , Basave H N L , Cortés-González R , Lagarde S M , van Lanschot J J B , Cords C , Jansen W A , Martijnse I , Matthijsen R , Bouwense S , Klarenbeek B , Verstegen M , van Workum F , Ruurda J P , van der Sluis P C , de Maat M , Evenett N , Johnston P , Patel R , MacCormick A , Smith B , Ekwunife C , Memon A H , Shaikh K , Wajid A , Khalil N , Haris M , Mirza Z U , Qudus S B A , Sarwar M Z , Shehzadi A , Raza A , Jhanzaib M H , Farmanali J , Zakir Z , Shakeel O , Nasir I , Khattak S , Baig M , Noor M A , Ahmed H H , Naeem A , Pinho A C , da Silva R , Bernardes A , Campos J C , Matos H , Braga T , Monteiro C , Ramos P , Cabral F , Gomes M P , Martins P C , Correia A M , Videira J F , Ciuce C , Drasovean R , Apostu R , Ciuce C , Paitici S , Racu A E , Obleaga C V , Beuran M , Stoica B , Ciubotaru C , Negoita V , Cordos I , Birla R D , Predescu D , Hoara P A , Tomsa R , Shneider V , Agasiev M , Ganjara I , Gunjić D , Veselinović M , Babič T , Chin T S , Shabbir A , Kim G , Crnjac A , Samo H , Díez del Val I , Leturio S , Ramón J M , Dal Cero M , Rifá S , Rico M , Pagan Pomar A , Martinez Corcoles J A , Rodicio Miravalles J L , Pais S A , Turienzo S A , Alvarez L S , Campos P V , Rendo A G , García S S , Santos E P G , Martínez E T , Fernández Díaz M J , Magadán Álvarez C , Concepción Martín V , Díaz López C , Rosat Rodrigo A , Pérez Sánchez L E , Bailón Cuadrado M , Tinoco Carrasco C , Choolani Bhojwani E , Sánchez D P , Ahmed M E , Dzhendov T , Lindberg F , Rutegård M , Sundbom M , Mickael C , Colucci N , Schnider A , Er S , Kurnaz E , Turkyilmaz S , Turkyilmaz A , Yildirim R , Baki B E , Akkapulu N , Karahan O , Damburaci N , Hardwick R , Safranek P , Sujendran V , Bennett J , Afzal Z , Shrotri M , Chan B , Exarchou K , Gilbert T , Amalesh T , Mukherjee D , Mukherjee S , Wiggins T H , Kennedy R , McCain S , Harris A , Dobson G , Davies N , Wilson I , Mayo D , Bennett D , Young R , Manby P , Blencowe N , Schiller M , Byrne B , Mitton D , Wong V , Elshaer A , Cowen M , Menon V , Tan L C , McLaughlin E , Koshy R , Sharp C , Brewer H , Das N , Cox M , Al Khyatt W , Worku D , Iqbal R , Walls L , McGregor R , Fullarton G , Macdonald A , MacKay C , Craig C , Dwerryhouse S , Hornby S , Jaunoo S , Wadley M , Baker C , Saad M , Kelly M , Davies A , Di Maggio F , McKay S , Mistry P , Singhal R , Tucker O , Kapoulas S , Powell-Brett S , Davis P , Bromley G , Watson L , Verma R , Ward J , Shetty V , Ball C , Pursnani K , Sarela A , Sue Ling H , Mehta S , Hayden J , To N , Palser T , Hunter D , Supramaniam K , Butt Z , Ahmed A , Kumar S , Chaudry A , Moussa O , Kordzadeh A , Lorenzi B , Wilson M , Patil P , Noaman I , Bouras G , Evans R , Singh M , Warrilow H , Ahmad A , Tewari N , Yanni F , Couch J , Theophilidou E , Reilly J J , Singh P , van Boxel G , Akbari K , Zanotti D , Sanders G , Wheatley T , Ariyarathenam A , Reece-Smith A , Humphreys L , Choh C , Carter N , Knight B , Pucher P , Athanasiou A , Mohamed I , Tan B , Abdulrahman M , Vickers J , Akhtar K , Chaparala R , Brown R , Alasmar M M A , Ackroyd R , Patel K , Tamhankar A , Wyman A , Walker R , Grace B , Abbassi N , Slim N , Ioannidi L , Blackshaw G , Havard T , Escofet X , Powell A , Owera A , Rashid F , Jambulingam P , Padickakudi J , Ben-Younes H , Mccormack K , Makey I A , Karush M K , Seder C W , Liptay M J , Chmielewski G , Rosato E L , Berger A C , Zheng R , Okolo E , Singh A , Scott C D , Weyant M J , Mitchell J D 
Published: January 2022

Abstract

Background
Textbook outcome has been proposed as a tool for the assessment of oncological surgical care. However, an international assessment in patients undergoing oesophagectomy for oesophageal cancer has not been reported. This study aimed to assess textbook outcome in an international setting.

Methods
Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018 to December 2018. Textbook outcome was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. A multivariable binary logistic regression model was used to identify factors independently associated with textbook outcome, and results are presented as odds ratio (OR) and 95 per cent confidence intervals (95 per cent c.i.).

Results
Of 2159 patients with oesophageal cancer, 39.7 per cent achieved a textbook outcome. The outcome parameter ‘no major postoperative complication’ had the greatest negative impact on a textbook outcome for patients with oesophageal cancer, compared to other textbook outcome parameters. Multivariable analysis identified male gender and increasing Charlson comorbidity index with a significantly lower likelihood of textbook outcome. Presence of 24-hour on-call rota for oesophageal surgeons (OR 2.05, 95 per cent c.i. 1.30 to 3.22; P = 0.002) and radiology (OR 1.54, 95 per cent c.i. 1.05 to 2.24; P = 0.027), total minimally invasive oesophagectomies (OR 1.63, 95 per cent c.i. 1.27 to 2.08; P &lt; 0.001), and chest anastomosis above azygous (OR 2.17, 95 per cent c.i. 1.58 to 2.98; P &lt; 0.001) were independently associated with a significantly increased likelihood of textbook outcome.

Conclusion
Textbook outcome is achieved in less than 40 per cent of patients having oesophagectomy for cancer. Improvements in centralization, hospital resources, access to minimal access surgery, and adoption of newer techniques for improving lymph node yield could improve textbook outcome.