ArticleAnnals of surgical oncology2026
Validation of Textbook Outcome in Gastric Surgery (TOGS) for Primary Gastric Cancer in an Eastern High-Volume Center.
Article in Annals of surgical oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Who cites it
1 citing paper in PubMed.
- ASO Author Reflections: Need for a Textbook Outcome in Gastric Surgery (TOGS) Specific for Gastric Cancer.Annals of surgical oncology · 2026Article
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16 authors.
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Abstract
backgroundTextbook Outcome defines the ideal perioperative course after surgery. A specific Textbook Outcome in Gastric Surgery (TOGS) was developed in Western centers; however, its validation among Eastern patients has rarely been investigated. We assessed its achievement in a Korean cohort and identified its predictors.
methodsWe included adults who underwent curative distal or total gastrectomy for gastric cancer (GC) between 2013 and 2023. TOGS consisted of three surgical criteria (no intraoperative complications, R0 resection, and adequate lymphadenectomy: > 20 nodes in subtotal and > 25 in total gastrectomy) and four postoperative criteria (no re-intervention, no unplanned intensive care unit stay, no unplanned 90-day readmission or mortality).
resultsOf the 5806 patients with GC enrolled, 4338 (74.7%) achieved the TOGS, with rates of 77.9% for stage I tumors and 68.8% for stages II-III. The TOGS rate declined with age, from 82.3% in patients aged < 40 years to 67.5% in those aged >80 years, with hospital readmission being the strongest negative predictor of its achievement in the elderly. Several factors were independently associated with a higher likelihood of TOGS: early lesions (P = 0.003), female sex (P < 0.001), recent surgery (P = 0.024), distal gastrectomy (P < 0.001), and minimally invasive approach (P < 0.001). Patients with TOGS had shorter hospital stays (P = 0.014) and improved 5-year overall survival (87.6%, vs. 75.6%, P < 0.001), independent of the pathological stage (stage I, P < 0.001; stages II-III, P < 0.001).
conclusionsThe new definition of TOGS provides valuable insights into the quality of surgical care for patients with GC and has a strong impact on oncological outcomes, including in Eastern patients.
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