What question did this study set out to answer?

This research aims to validate the Textbook Outcome in Gastric Surgery (TOGS) for gastric cancer patients in an Eastern context.

April 5, 2026Annals of Surgical Oncology1 citationsOpen Access

Validation of Textbook Outcome in Gastric Surgery (TOGS) for Primary Gastric Cancer in an Eastern High-Volume Center

LCL. CarboneUniversity of Siena YCYo-Seok ChoSeoul National University MKMin Kyu KangSeoul National University

Key Points

This research aims to validate the Textbook Outcome in Gastric Surgery (TOGS) for gastric cancer patients in an Eastern context.
Included patients who underwent curative distal or total gastrectomy for gastric cancer from 2013 to 2023.
Evaluated achievement of TOGS based on surgical and postoperative criteria.
Analyzed data to identify predictors of TOGS achievement.
74.7% of patients achieved TOGS; higher rates in stage I tumors (77.9%) compared to stages II–III (68.8%).
TOGS rates decreased with age, notably from 82.3% (<40 years) to 67.5% (>80 years).
Hospital readmission was identified as a strong negative predictor of TOGS achievement.
Factors associated with higher TOGS likelihood included early lesions, female sex, recent surgery, distal gastrectomy, and minimally invasive approach.

Abstract

Abstract Background Textbook Outcome defines the ideal perioperative course after surgery. A specific Textbook Outcome in Gastric Surgery (TOGS) was developed in Western centers; however, its validation among Eastern patients has rarely been investigated. We assessed its achievement in a Korean cohort and identified its predictors. Methods We included adults who underwent curative distal or total gastrectomy for gastric cancer (GC) between 2013 and 2023. TOGS consisted of three surgical criteria (no intraoperative complications, R0 resection, and adequate lymphadenectomy: > 20 nodes in subtotal and > 25 in total gastrectomy) and four postoperative criteria (no re-intervention, no unplanned intensive care unit stay, no unplanned 90-day readmission or mortality). Results Of the 5806 patients with GC enrolled, 4338 (74.7%) achieved the TOGS, with rates of 77.9% for stage I tumors and 68.8% for stages II–III. The TOGS rate declined with age, from 82.3% in patients aged 80 years, with hospital readmission being the strongest negative predictor of its achievement in the elderly. Several factors were independently associated with a higher likelihood of TOGS: early lesions ( P = 0.003), female sex ( P < 0.001), recent surgery ( P = 0.024), distal gastrectomy ( P < 0.001), and minimally invasive approach ( P < 0.001). Patients with TOGS had shorter hospital stays ( P = 0.014) and improved 5-year overall survival (87.6%, vs. 75.6%, P < 0.001), independent of the pathological stage (stage I, P < 0.001; stages II–III, P < 0.001). Conclusions The new definition of TOGS provides valuable insights into the quality of surgical care for patients with GC and has a strong impact on oncological outcomes, including in Eastern patients.

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