Purpose: The textbook outcome (TBO), a multidimensional indicator that reflects an optimal perioperative course, has emerged as a significant prognostic variable in surgical oncology. Our study aimed to assess the occurrence and determinants of TBO following minimally invasive esophagectomy (MIE) for cancer. Methods: A total of 945 patients who had undergone MIE at two high-volume centers between 2008 and 2022 were analyzed. Multivariable logistic regression analysis was applied to identify the independent predictors of TBO. The potential selection bias associated with choosing between different MIE techniques—namely, robotic esophagectomy (RE) and video-assisted thoracoscopic esophagectomy (VATE)—was addressed by applying inverse probability of treatment weighting (IPTW). Results: TBO was realized in 46.6% of cases (n= 440), correlating with markedly better overall and disease-free survival. Multivariable analysis showed that treatment with RE (odds ratio (OR) = 1.527; 95% confidence interval (CI) = 1.149–2.028) was associated with a higher likelihood of achieving TBO, whereas a Charlson Comorbidity Index (CCI) of 2 or higher showed an opposite association (CCI2: OR = 0.687, 95% CI = 0.483–0.977; CCI ≥ 3: OR = 0.604, 95% CI = 0.399–0.915). The advantage of RE in attaining a higher rate of TBO, compared to VATE, remained statistically significant after applying IPTW, with rates of 53.3% for RE and 42.2% for VATE. Notably, RE contributed to a greater probability of thorough lymph node dissection, resection with negative margins, and the avoidance of major complications. Conclusion: TBO was realized in 46.6% of the patients who underwent MIE for cancer. Patients with a lower CCI and those who received RE were more likely to achieve TBO.
目的：教科书结局（TBO）作为一种反映理想围手术期过程的多维指标，已成为肿瘤外科领域重要的预后变量。本研究旨在评估癌症患者接受微创食管切除术（MIE）后TBO的发生率及其影响因素。方法：对2008年至2022年间在两个大型医疗中心接受MIE的945例患者进行分析。采用多变量逻辑回归分析确定TBO的独立预测因素。针对机器人食管切除术（RE）与视频辅助胸腔镜食管切除术（VATE）两种术式选择可能产生的偏倚，采用逆概率处理加权法（IPTW）进行校正。结果：46.6%的病例（n=440）实现了TBO，该结果与显著改善的总生存期和无病生存期密切相关。多变量分析显示，接受RE治疗（比值比=1.527；95%置信区间=1.149–2.028）与实现TBO的可能性更高相关，而查尔森合并症指数（CCI）≥2则呈现负相关（CCI2：比值比=0.687，95%置信区间=0.483–0.977；CCI≥3：比值比=0.604，95%置信区间=0.399–0.915）。经IPTW校正后，RE在实现更高TBO率方面仍保持统计学优势（RE组53.3% vs VATE组42.2%）。值得注意的是，RE在实现更彻底的淋巴结清扫、阴性切缘切除以及避免重大并发症方面具有更高概率。结论：在接受MIE治疗的癌症患者中，46.6%实现了TBO。CCI评分较低及接受RE治疗的患者更可能达成TBO。
肿瘤(癌症)患者之家