1. Surgery by a minimally invasive approach is associated with improved textbook outcomes in oesophageal and gastric cancer
- Author
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Jack Allen, Michael E. Kelly, Luke Trench, William B. Robb, Mohammed Al Azzawi, Mayilone Arumugasamy, Jack Whooley, Eamonn M. Bolger, Jarlath C. Bolger, and Conor Brosnan
- Subjects
Oncology ,Adult ,Male ,medicine.medical_specialty ,Neoplasm, Residual ,Esophageal Neoplasms ,medicine.medical_treatment ,Population ,030230 surgery ,Malignancy ,Resection ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Gastrectomy ,Stomach Neoplasms ,Internal medicine ,Overall survival ,Medicine ,Humans ,Minimally Invasive Surgical Procedures ,education ,Pathological ,Aged ,Proportional Hazards Models ,Retrospective Studies ,Aged, 80 and over ,education.field_of_study ,business.industry ,Outcome measures ,Cancer ,Margins of Excision ,General Medicine ,Middle Aged ,medicine.disease ,Neoadjuvant Therapy ,Esophagectomy ,Survival Rate ,Treatment Outcome ,030220 oncology & carcinogenesis ,Surgery ,Female ,business - Abstract
Introduction Textbook outcome (TBO) is a composite measure of a number of peri-operative and clinical outcomes in oesophagogastric malignancy. It has previously been shown that TBOs are associated with improved overall survival in both oesophageal and gastric cancer. The influence of a minimally invasive approach (MIA) on TBO is not well defined. The purpose of this study is to validate TBO in our population, examine the influence of a MIA on achieving a TBO, and the impact of TBO on long-term survival. Methods 269 patients undergoing oesophagectomy and 258 patients undergoing subtotal or total gastrectomy were included in this study. Demographic, clinical and pathological differences between patients with and without a TBO were compared using univariable and multivariable analysis. Overall survival for those with and without a TBO was examined. The influence of MIA on overall survival and TBO was determined using Cox proportional hazard models. Results Patients undergoing oesophagectomy and gastrectomy were significantly more likely to achieve a TBO when MIA was used (p = 0.01 and 0.001 respectively). When MIA is included as an outcome measure patients achieving a TBO show improved overall survival in both oesophageal and gastric cancer. MIA, clear resection margins and no unplanned admission to critical care are the strongest predictors of overall survival from the putative bundle of TBO parameters. Conclusion Minimally invasive surgery is associated with improved TBO. Completion of a minimally invasive approach should be considered for inclusion as a textbook parameter.
- Published
- 2020