Assessment of textbook oncologic outcomes following gastrectomy for gastric cancer: 2019 Korean gastric cancer association survey database

Surg Oncol. 2026 Jul 2;67:102498. doi: 10.1016/j.suronc.2026.102498. Online ahead of print.

ABSTRACT

PURPOSE: Textbook oncologic outcome (TOO) is increasingly used to assess surgical quality in oncology; however, its application in gastric cancer surgery remains relatively limited. This study aimed to evaluate the achievement of TOO and identify associated clinicopathological factors in patients undergoing gastrectomy for gastric cancer.

METHODS: We analyzed data from a 2019 nationwide survey conducted by the Korean Gastric Cancer Association, which included 11,964 patients who underwent gastrectomy. TOO was defined as concurrent fulfillment of the following five criteria: (1) R0 resection; (2) assessment of at least 15 lymph nodes; (3) no extended hospital stay beyond the 75th percentile; (4) administration of appropriate postoperative chemotherapy; and (5) absence of 30-day postoperative mortality. Among the included patients, 68.5% met all five TOO criteria. Multivariate logistic regression analysis revealed several factors significantly associated with TOO achievement. Younger age, female sex, higher body mass index, lower American Society of Anesthesiologists score, minimally invasive surgical approaches (laparoscopic or robotic), partial rather than total gastrectomy, smaller tumor size, undifferentiated histology, and the absence of lymphovascular or perineural invasion were positively correlated with TOO.

CONCLUSION: TOO was achieved in approximately two-thirds of the patients with gastric cancer who underwent gastrectomy in Korea. These findings suggest that TOO is a valuable metric for short-term surgical quality in gastric cancer, and may serve as a meaningful tool for outcome evaluation and healthcare quality improvement. Notably, female patients were more likely to achieve TOO, indicating potential biological or systemic differences that warrant further investigation.

PMID:42413302 | DOI:10.1016/j.suronc.2026.102498