Evidence map›Paper›PMID 41003945›Full record

ArticleGastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association2025

Textbook outcome in gastrectomy: useful metric or moving target? A scoping review.

Riadh Salem, Lorenzo Giorgi, Wing K Chou, Sheraz R Markar

Abstract readScoping Review
PubMed Full text at PMC Publisher
In one paragraph

Article in Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed.

  1. Review
  2. Observational
  3. Impairment in activities of daily living and textbook outcome after major emergency abdominal surgery.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2026
    Article
  4. Article
  5. Article
  6. Article
  7. Textbook outcome in gastric cancer surgery: a multicenter cohort study and proposal for a new specific index (TOGS).Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association · 2026
    Article
  8. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors.

Riadh SalemSurgical Intervention Trials Unit, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.ORCID 0000-0002-2507-2006
Lorenzo GiorgiSurgical Intervention Trials Unit, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
Wing K ChouSurgical Intervention Trials Unit, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
Sheraz R MarkarSurgical Intervention Trials Unit, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK. sheraz.markar@nds.ox.ac.uk.

Funding

National Institute for Health and Care Research NIHR305100
6 · The paper itself

Abstract

backgroundComposite metrics including Textbook Outcome (TO) and Textbook Oncological Outcome (TOO) are increasingly utilised to assess quality in gastric cancer surgical research. However, inconsistent and variable reporting limits their clinical application.

objectiveThis scoping review aimed to catalogue definitions and criteria of TO and TOO in gastrectomy, report achievement rates and determinants, associations with survival outcomes, and identify methodological gaps.

methodsA search was conducted in MEDLINE, Embase, Web of Science, and Scopus from inception to April 2025. Eligible studies reported TO or TOO for adults undergoing curative-intent gastrectomy for cancer. Reviewers screened studies and extracted data on characteristics, definitions, achievement rates, and survival outcomes. Owing to heterogeneity, findings were summarised narratively.

resultsForty-five studies (published 2017-2025; n = 139,972 patients) were included. Definitions varied, with 26 unique components identified. Common components were adequate lymphadenectomy (≥ 15 nodes), absence of postoperative complications (Clavien-Dindo grade ≥ II), and no 30-day readmission. Median TO and TOO achievement rates were 58.6% (IQR: 37.6-75.8) and 30.3% (IQR: 23.6-40.2). The primary barriers were inadequate lymphadenectomy and CD ≥ II complications. Twelve studies reported a significant association between TO/TOO and improved overall and disease-free survival. Influencing factors included age, comorbidity, tumour characteristics, surgeon volume, and surgical approach. Limitations included non-standardised definitions, limited patient-reported outcomes, and a lack of prospective validation.

conclusionTO and TOO are associated with improved survival in gastrectomy but are hampered by inconsistent definitions and limited prospective evidence. Standardisation, patient-reported outcomes, and prospective validation are needed to realise their potential as clinically useful quality metrics.

Indexed as

GastrectomyOutcome Assessment, Health CareStomach NeoplasmsHumansPostoperative ComplicationsSurvival RateGastrectomySurgical qualityTextbook outcome

Identifiers

PMID41003945
PMCPMC12630219

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.