Textbook Outcomes and Survival in Gastric Cancer Surgery: Results of a French-Speaking Multicenter Study
In brief
Only about 42% of gastric cancer surgeries meet textbook outcome, and those patients live longer
In a French-speaking multicenter review of 958 gastric cancer operations, 398 patients (41.5%) achieved all textbook outcome criteria and showed significantly better overall and disease-free survival. Failure to meet the criteria was linked to obesity (BMI > 30) and tumors on the lesser curvature, suggesting these factors may guide quality improvement efforts.
- Journal
- World journal of surgery (Q1)
- Published
- 16 September 2026
- Study design
- Cohort / observational study
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Ophélie Bacoeur-Ouzillou, Florian Martinet-Kosinski, Julie Veziant, Gilles Manceau, Jérome Guiramand, Thibault Voron, et al.
- PMID
- 42746996
- DOI
- 10.1002/wjs.70577
Why clinicians should know about it
- Picked for Gastrointestinal and Colorectal Surgery (paper of the day, 19 September 2026): Textbook outcomes link to gastric cancer survival
Abstract
BACKGROUND: TO is a composite parameter used to assess surgical care quality. In oncologic gastric surgery, TO includes the following criteria: complete potentially curative resection during operation, no intraoperative complications, resection of at least 15 lymph nodes, absence of severe postoperative complications, no prolonged hospital stay, no reoperation, no postoperative mortality, and achievement of R0 resection. The objective of the study is to investigate the achievement of textbook outcome (TO) and its association with overall survival in patients treated for gastric cancer and to identify factors that contribute to the failure to meet TO criteria. MATERIALS AND METHODS: This multicenter French-speaking center retrospective study, based on data from the French Association of Surgery database, analyzed 2131 patients treated for gastric cancer between 2007 and 2017. Patients who met the TO criteria were compared with those who did not. RESULTS: Among the 958 eligible patients, TO was achieved in 398 (41.5%) patients. TO achievement was significantly associated with improved overall survival (p < 0.01) and disease-free survival (p < 0.01). In the univariate analysis, factors associated with failure to achieve TO included age, body mass index, tumor location and stage, neoadjuvant treatment, and type of gastrectomy. In the multivariate analysis, only BMI > 30 and tumor of the lesser curvature treatment remained significantly associated with failure to achieve TO. CONCLUSION: TO is associated with improved overall and disease-free survival in patients undergoing surgery for gastric cancer. BMI < 30 and tumor of the lesser curvature were independently associated with a higher rate of TO.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.