461. EVALUATION OF TEXTBOOK OUTCOMES AND LONG-TERM PROGNOSIS FOLLOWING ESOPHAGECTOMY: A RETROSPECTIVE COHORT STUDY
Bibliographic record
Abstract
Abstract Background A textbook outcome (TBO) has become a quality benchmark for perioperative esophagectomy. In 2021, by international consensus, TBO was redefined to include: R0 resection, retrieval of ≥20 lymph nodes, absence of intraoperative complications, no major complications (Clavien-Dindo ≥ III), no anastomotic leak, ICU/MCU readmission, prolonged hospital stay (≥ 14 days), in-hospital mortality, or readmission related to the surgical procedure. Using this updated definition, this study aims to evaluate the proportion of patients achieving TBO at a high-volume tertiary care centre and explore the association between TBO achievement and long-term outcomes, as well as early postoperative quality of life measured by FACT-E. Methods This retrospective study included patients who underwent esophagectomy for cancer at our institution from January 2021 onward. Patients were excluded if they had missing data related to any TBO criterion or long-term outcomes. TBO was achieved when all the defined criteria were met. Long-term outcomes of interest included overall survival, recurrence, and metastasis at 1-, 2-, and 3-year post-esophagectomy follow-ups. Descriptive statistics were used to quantify TBO rates and failure reasons. Univariate analyses were conducted to compare differences between TBO and non-TBO groups. Associations between 1-month postoperative FACT-E scores and TBO status were assessed to compare differences between groups. Results Of 380 patients identified, 156 (41%) met inclusion criteria, with 44 (28%) achieving TBO. Post-operative complications of Clavien Dindo ≥ III (93%) and prolonged hospital stay (92%) were the most common reasons for non-achievement. Recurrence and metastasis rates were consistently lower in TBO achievers, including at 3 years (14% vs. 29%, p = 0.1757; 7% vs. 14%, p = 0.3527, respectively). Although not statistically significant, 3-year survival was higher in TBO achievers (79% vs. 55%, p = 0.1294). FACT-E scores at 1 month postoperatively did not differ significantly (TBO: median 115 [range 83–165]; non-TBO: median 111 [range 39–154], p = 0.1336). Conclusion Among patients with complete data, approximately one in four achieved a TBO under the 2021 definition, highlighting the challenge of attaining all perioperative quality benchmarks in esophagectomy. Complication severity and prolonged hospitalization were the most common reasons for failure. While not statistically significant, the trends towards lower recurrence, metastasis, and improved survival in TBO achievers underscore the potential prognostic value of TBO. Further research is needed to better understand how optimizing perioperative care can enhance long-term prognosis in esophageal cancer patients.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".