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Background <p>Textbook outcome is a composite measure reflecting an ideal perioperative course by integrating multiple care-quality indicators. While its use has been reported internationally for non-small cell lung cancer (NSCLC) resection, it has not previously been evaluated in the Australian setting. This study aimed to determine the proportion of patients achieving a textbook outcome after NSCLC resection, identify the components that most commonly prevented its attainment, and evaluate its association with long-term overall survival.</p> Methods <p>A retrospective cohort study was conducted of adults undergoing lung resection for primary NSCLC at a tertiary Australian centre (2011–2023). Textbook outcome was defined according to the Dutch Lung Cancer Audit–Surgery criteria, requiring negative margins, complete lymph node dissection, absence of major complications, no 30-day mortality or reintervention, no prolonged ICU/high-dependency stay, no prolonged hospitalisation, and no readmission. Multivariable logistic regression identified predictors of textbook outcome, and Kaplan–Meier analysis was used to assess long-term survival.</p> Results <p>Of 731 patients, 163 (22.3%) met all textbook outcome criteria. Failure to achieve the composite outcome was most commonly caused by incomplete lymph node dissection (67.6%), reintervention (22.5%), major complications (20.2%), or prolonged stay (13.2%). Male sex (OR 0.53, 95% CI 0.36–0.77) and open surgery (OR 0.54, 95% CI 0.35–0.83) were associated with lower odds of meeting the criteria, while carcinoid histology increased the odds (OR 1.91, 95% CI 1.04–3.45). Patients who met the textbook outcome criteria had higher survival (5-year: 89.7% vs. 70.8%; 10-year: 82.0% vs. 60.7%; log-rank <i>p &lt;</i> 0.001).</p> Conclusion <p>Textbook outcome was achieved in approximately one-fifth of patients and was strongly associated with improved long-term survival. Enhancing lymph node dissection and wider adoption of minimally invasive surgery may help increase textbook outcome rates and represents a potential focus for future quality-improvement initiatives.</p> Trial registration <p>This study was retrospectively registered in the Australian-New Zealand Clinical Trials Registry (ACTRN12625000913471).</p>

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Textbook outcome and long-term survival after pulmonary resection for non-small cell lung cancer: a retrospective cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月15日

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  • Nattaya Raykateeraroj,
  • Fabien Chu,
  • Je Min Suh,
  • Luca Petterlin,
  • Ella Francis,
  • Junyan Zhao,
  • Prabhashi Ratnayakemudiyanselage,
  • Fawaz Ahmed Prem Navaz,
  • Chin Jin Ker,
  • Sepideh Roshanaei,
  • Harry Botta,
  • Jacques Elias,
  • Evina Ling,
  • Ronald Ma,
  • Stephen A. Barnett,
  • Simon Knight,
  • Dong-Kyu Lee,
  • Laurence Weinberg

摘要

Background

Textbook outcome is a composite measure reflecting an ideal perioperative course by integrating multiple care-quality indicators. While its use has been reported internationally for non-small cell lung cancer (NSCLC) resection, it has not previously been evaluated in the Australian setting. This study aimed to determine the proportion of patients achieving a textbook outcome after NSCLC resection, identify the components that most commonly prevented its attainment, and evaluate its association with long-term overall survival.

Methods

A retrospective cohort study was conducted of adults undergoing lung resection for primary NSCLC at a tertiary Australian centre (2011–2023). Textbook outcome was defined according to the Dutch Lung Cancer Audit–Surgery criteria, requiring negative margins, complete lymph node dissection, absence of major complications, no 30-day mortality or reintervention, no prolonged ICU/high-dependency stay, no prolonged hospitalisation, and no readmission. Multivariable logistic regression identified predictors of textbook outcome, and Kaplan–Meier analysis was used to assess long-term survival.

Results

Of 731 patients, 163 (22.3%) met all textbook outcome criteria. Failure to achieve the composite outcome was most commonly caused by incomplete lymph node dissection (67.6%), reintervention (22.5%), major complications (20.2%), or prolonged stay (13.2%). Male sex (OR 0.53, 95% CI 0.36–0.77) and open surgery (OR 0.54, 95% CI 0.35–0.83) were associated with lower odds of meeting the criteria, while carcinoid histology increased the odds (OR 1.91, 95% CI 1.04–3.45). Patients who met the textbook outcome criteria had higher survival (5-year: 89.7% vs. 70.8%; 10-year: 82.0% vs. 60.7%; log-rank p < 0.001).

Conclusion

Textbook outcome was achieved in approximately one-fifth of patients and was strongly associated with improved long-term survival. Enhancing lymph node dissection and wider adoption of minimally invasive surgery may help increase textbook outcome rates and represents a potential focus for future quality-improvement initiatives.

Trial registration

This study was retrospectively registered in the Australian-New Zealand Clinical Trials Registry (ACTRN12625000913471).