ArticleWorld journal of surgical oncology2026
Textbook outcome and long-term survival after pulmonary resection for non-small cell lung cancer: a retrospective cohort study.
Article in World journal of surgical oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundTextbook 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.
methodsA 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.
resultsOf 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).
conclusionTextbook 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 registrationThis study was retrospectively registered in the Australian-New Zealand Clinical Trials Registry (ACTRN12625000913471).
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