Evidence map›Paper›PMID 41511638›Full record

ArticleGastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association2026

Textbook outcome in gastric cancer surgery: a multicenter cohort study and proposal for a new specific index (TOGS).

Daniele Marrelli, Ludovico Carbone, Stefania Angela Piccioni, Lorena Torroni, Elio Treppiedi, Silvia Ministrini, Leonardo Solaini, Rossella Reddavid, Marina Valente, Laura Fortuna and 24 more

Abstract readMulticenter Study
PubMed Publisher
In one paragraph

Article in Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing 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

4 citing papers in PubMed.

  1. Review
  2. Article
  3. Article
  4. 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

34 authors.

Daniele MarrelliUnit of General Surgery, Department of Medicine Surgery and Neuroscience, University of Siena, AOUS, Siena, 53100, Italy. daniele.marrelli@unisi.it.
Ludovico CarboneUnit of General Surgery, Department of Medicine Surgery and Neuroscience, University of Siena, AOUS, Siena, 53100, Italy.
Stefania Angela PiccioniUnit of General Surgery, Department of Medicine Surgery and Neuroscience, University of Siena, AOUS, Siena, 53100, Italy.
Lorena TorroniGeneral and Upper GI Surgery Division, Department of Surgery, University of Verona, Verona, 37126, Italy.
Elio TreppiediDivision of Gastrointestinal Surgery, San Raffaele Hospital, Vita Salute University, Milan, 20132, Italy.
Silvia MinistriniSurgical Clinic, Department of Experimental and Clinical Sciences, University of Brescia, Brescia, 25123, Italy.
Leonardo SolainiGeneral and Oncologic Surgery, Morgagni-Pierantoni Hospital, Forlì, 47121, Italy.
Rossella ReddavidDivision of Surgical Oncology and Digestive Surgery, Department of Oncology, San Luigi University Hospital, University of Turin, Turin, 10043, Italy.
Marina ValenteUnit of General Surgery, Department of Surgery, Parma University Hospital, Parma, 43100, Italy.
Laura FortunaUnit of Digestive Surgery, Department of Experimental and Clinical Medicine, University of Florence, Careggi University Hospital, Florence, 50121, Italy.
Stefano De PascaleDigestive Surgery, European Institute of Oncology, IRCCS, Milan, 20141, Italy.
Mattia BerselliGeneral Surgical Unit I, Department of Surgery, ASST Settelaghi, Varese, 21100, Italy.
Cecilia RidolfiDivision of Surgery, Infermi Hospital, AUSL Romagna, Rimini, 47900, Italy.
Luigina GraziosiGeneral and Emergency Surgery, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, 06123, Italy.
Flavia CarliniDepartment of Surgery, University of Genova, Genova, 16132, Italy.
Pietro Maria LombardiDivision of Minimally Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Milan, 20162, Italy.
Stefano RauseiDepartment of General Surgery, Cittiglio-Angera Hospital, ASST Settelaghi, Varese, 21033, Italy.
Fausto RosaDepartment of Digestive Surgery, A. Gemelli Hospital, Catholic University, Roma, 00168, Italy.
Giovanni CameriniDepartment of Surgery, University of Genova, Genova, 16132, Italy.
Annibale DoniniGeneral and Emergency Surgery, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, 06123, Italy.
Gianluca GarulliDivision of Surgery, Infermi Hospital, AUSL Romagna, Rimini, 47900, Italy.
Eugenio CocozzaGeneral Surgical Unit I, Department of Surgery, ASST Settelaghi, Varese, 21100, Italy.
Uberto Fumagalli RomarioDigestive Surgery, European Institute of Oncology, IRCCS, Milan, 20141, Italy.
Fabio CianchiUnit of Digestive Surgery, Department of Experimental and Clinical Medicine, University of Florence, Careggi University Hospital, Florence, 50121, Italy.
Federica FilippiniGeneral and Upper GI Surgery Division, Department of Surgery, University of Verona, Verona, 37126, Italy.
Paolo MorgagniGeneral and Oncologic Surgery, Morgagni-Pierantoni Hospital, Forlì, 47121, Italy.
Ugo ElmoreDivision of Gastrointestinal Surgery, San Raffaele Hospital, Vita Salute University, Milan, 20132, Italy.
Federico MarchesiUnit of General Surgery, Department of Surgery, Parma University Hospital, Parma, 43100, Italy.
Maurizio DegiuliDivision of Surgical Oncology and Digestive Surgery, Department of Oncology, San Luigi University Hospital, University of Turin, Turin, 10043, Italy.
Giorgio ErcolaniGeneral and Oncologic Surgery, Morgagni-Pierantoni Hospital, Forlì, 47121, Italy.
Guido Alberto Massimo TiberioSurgical Clinic, Department of Experimental and Clinical Sciences, University of Brescia, Brescia, 25123, Italy.
Simone GiacopuzziGeneral and Upper GI Surgery Division, Department of Surgery, University of Verona, Verona, 37126, Italy.
Riccardo RosatiDivision of Gastrointestinal Surgery, San Raffaele Hospital, Vita Salute University, Milan, 20132, Italy.
Franco RovielloUnit of General Surgery, Department of Medicine Surgery and Neuroscience, University of Siena, AOUS, Siena, 53100, Italy.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundTextbook Outcome (TO) combines optimal surgical outcomes into a single measure. This study evaluates achievement of TO using a multicenter database, assessing hospital variation, its correlation with early and late results, and refining a tailored definition of Textbook Outcome in Gastric Surgery (TOGS).

methodsData from patients undergoing curative gastrectomy (2011–2020) in Italian centers affiliated to the Italian Gastric Cancer Research Group (GIRCG) were analyzed. TOGS was introduced at the 2024 GIRCG Annual Meeting in Siena (Italy).

resultsAmong 1988 patients (median age 72 years, BMI 24.9 kg/m2), 1523 underwent surgery in higher-volume centers (≥ 30 cases per year) and 465 in lower-volume centers (15–30 cases per year). TO was achieved in 54.6% of patients (55.2% in higher-volume vs. 52.7% in lower-volume centers, P = 0.350). Clavien-Dindo grade II or higher complications (34.8%) and re-interventions (11.5%) mostly affected the achievement of TO. Younger age (P < 0.001), early stages (P < 0.001), female gender (P = 0.005), open approach (P = 0.008) and absence of extensive surgery (P = 0.033) were independent predictors of TO. Patients achieving TO showed better survival (5-y 69.8% vs. 57.3%, HR 0.63 [95% CI, 0.54–0.75], P < 0.001), also when stratifying for tumor stages. The new TOGS definition, based on specific criteria for gastric surgery, reduced its achievement rate (50.2%) but shortened mean hospital stay (8.9 vs. 18 days) and increased the likelihood of long-term survival.

conclusionsTO and TOGS are valuable metrics for assessing hospital performance and optimizing outcomes following gastrectomy for gastric cancer. Hospital volume did not impact TO and TOGS rates in GIRCG centers.

Indexed as

GastrectomyPostoperative ComplicationsStomach NeoplasmsAgedAged, 80 and overCohort StudiesFemaleHospitals, High-VolumeHumansItalyMaleMiddle AgedTreatment OutcomeGastrectomyGastric cancerSurgical qualityTextbook outcomeVolume.

Identifiers

PMID41511638

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

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.