Textbook Outcome Is Associated with Improved Survival after Resection of Colorectal Liver Metastases

Abstract

Introduction: “Textbook outcomes” are composite measures of care which may be superior in assessing quality compared to traditional methods. The aim of this study was to define textbook outcomes (TBO) specific to surgical resection of colorectal liver metastases (CRLM) and assess their impact on survival. Methods: Consecutive patients undergoing liver resection for CRLM from 2009-2020 were studied. Cox proportional hazards regression was used to identify perioperative outcomes associated with overall survival (OS), which were then retained with key postoperative outcomes to define a TBO for resection of CRLM. The impact of achievement of a TBO on OS was then determined. Results: TBO was achieved in 72.1% (197/273) of patients. Major morbidity (Clavien-Dindo ≥3) at 27.5% was the most frequent reason not to achieve a TBO. Multivariable analysis showed that age >65 years, ASA Grade III-IV and resection of >2 segments independently predicted failure to achieve a TBO. TBO was associated with improved 3-year (77% vs. 55%), 5-year (60.7% vs. 42.5%) and median (93 months vs. 44 months) overall survival (p = .006). Conclusion: TBO is a useful composite measure in surgery for CRLM. It can highlight areas which may be targeted for quality improvement and may be useful as a tool to examine variation between centres. Achieving a TBO is associated with a significant improvement in survival.