BACKGROUND AND AIMS: Textbook outcome (TO) and textbook oncological outcome (TOO) are two multidimensional quality measures designed to evaluate and benchmark the surgical and oncological outcomes following esophagectomy. Most studies on TO and TOO originate from high-volume tertiary centers, whereas less is known about the outcome from low- to medium-sized centers. METHODS: Retrospective national cohort study of patients operated for esophageal cancer with Ivor Lewis or McKeown esophagectomy between 07/2021 and 06/2025. The primary outcome was the fraction of patients achieving TO defined as no 30-days mortality, no Clavien-Dindo complications ≥ III, length of hospital stay < 21 days, R0 resection, no re-admissions within 30 days, ≥ 15 lymph nodes harvested and no intraoperative complications. The main secondary outcome was the proportion of patients achieving TOO, defined as achievement of TO and completed neoadjuvant (radio)chemotherapy. Patients were grouped according to type of resection. RESULTS: = 0.94, respectively); 30-day mortality was 1%. No predictive variables of TO were identified, specifically no association was found with the annual procedural center volume, type of resection or the use of robotic-assisted technique. CONCLUSIONS: Less than one in three patients achieved TO or TOO. Neither the annual procedure volume of the individual treatment centers nor the type of resection predicted TO. The lack of a consensus-based definition of TO and TOO makes comparisons across patient series challenging.
Hauge et al. (Thu,) studied this question.