Textbook Outcomes After Oesophagectomy in a Regional Australian Hospital: An Observational Study

Abstract Background Textbook outcomes is a composite tool to assess the quality of cancer care within an institution by evaluating several perioperative factors. Most studies assessing textbook outcomes after oesophagectomy have been conducted in high-volume centres, achieving rates of up to 50%. The primary aim of this study was to assess the textbook outcome rate after oesophagectomy of a single regional hospital in Australia and compare it to results from larger Australian and international centres. Secondary aims were to investigate the association between textbook outcomes, patient, tumour and treatment characteristics. Methods A retrospective observational study was performed on patients that underwent oesophagectomy at a single regional centre in Tasmania, between January 2014 and December 2023. Two consultant upper gastrointestinal surgeons performed all procedures. The surgical team is supported by a level 3 intensive care unit, interventional radiology services and gastroenterologists with interventional endoscopy skills. Textbook outcome was achieved when 10 criteria were met. The number of patients achieving each parameter was calculated, and several patient (age, gender, BMI, ASA), tumour (histology, T and N stage) and treatment (neoadjuvant therapy, surgical approach) -related parameters were assessed. Overall survival was also assessed. Results Sixty-five patients were identified. Ivor-Lewis oesophagectomy was performed via an open approach (58 patients, 89.2%). Hybrid 3-stage thoracoscopic oesophagectomy was performed in seven patients (10.8%). The overall textbook outcome rate was 32.3%. The most achieved parameters were R0 resection (100%) and no intraoperative complication (98.5%). The factors achieved least frequently were 15 lymph nodes (53.8%) and no reintervention (64.5%). A significant association was found between preoperative nodal stage and textbook outcome (p = 0.02). There was no difference in survival between patients with and without textbook outcomes. Conclusion Achieving higher rates of textbook outcomes remains a challenge, especially in the regional setting where access to services associated with higher rates of textbook outcomes may be limited. To the best of our knowledge this is the first study to assess textbook outcomes after oesophagectomy in a regional Australian hospital, providing a unique insight into the performance of this procedure in a country that has not widely adopted centralisation of cases.