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SYSTEMATIC REVIEW article
Front. Oncol.
Sec. Surgical Oncology
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1474008
Textbook Oncologic Outcomes in Colorectal Cancer Surgery: A Systematic Review
Provisionally accepted
Giang Son Arrighini1
Alessandro Martinino2
Victoria Zecchin Ferrara3
Laura Lorenzon4
Francesco Giovinazzo4*- 1University of Bologna, Bologna, Emilia-Romagna, Italy
- 2Duke University Medical Center, Duke University, Durham, North Carolina, United States
- 3University of Padua, Padua, Veneto, Italy
- 4Agostino Gemelli University Policlinic, Rome, Lazio, Italy
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Introduction: The concept of “Textbook Outcome” has been updated to encompass the principles of surgical oncology and the related outcomes (Textbook Oncologic Outcome - TOO). This systematic review aims to synthesize the numerous definitions of TOO in the context of colorectal surgery. The goal is to promote the development of a definition that has universal recognition and worldwide acceptability, hence improving surgical quality standards and patient outcomes.Methods: A systematic literature review was conducted using PRISMA guidelines. The databases PubMed, Web of Science, and Scopus were searched for studies that addressed TOO in colorectal cancer surgeries. The database search was conducted on April 30, 2024, and the primary study's quality was assessed using the Newcastle-Ottawa Scale.Results: A total of 13 studies were included. Common TOO parameters included radical resection, lymph node (LN) yield ≥ 12, no Clavien-Dindo grade ≥ III complications, length of stay (75th percentile), no 30-day readmissions and no 30-day mortality. Factors influencing TOO achievement included surgical risk, gender, tumor stage, and socioeconomic factors. Patients achieving TOO showed better long-term survival. Variability in TOO definitions highlighted the need for standardization.Conclusion: TOO is an effective indicator for evaluating the quality of colorectal cancer surgery. It provides a comprehensive evaluation of surgical outcomes, which helps in guiding patient decisions and measuring hospital performance. By standardizing the parameters of TOO, the consistency and quality of care across different institutions can be improved. We propose a unified definition of TOO for colorectal cancer surgery: radical resection, lymph node (LN) yield ≥ 12, no Clavien-Dindo grade ≥ III complications, length of stay (75th percentile), no 30-day readmissions and no 30-day mortality.
Keywords: Colon surgery, Rectal surgery, Textbook Outcome, textbook oncology outcome TO, textbook outcome TOO, textbook oncologic outcome CC, colon cancer RC, rectal cancer
Received: 06 Aug 2024; Accepted: 04 Apr 2025.
Copyright: © 2025 Arrighini, Martinino, Zecchin Ferrara, Lorenzon and Giovinazzo. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Francesco Giovinazzo, Agostino Gemelli University Policlinic, Rome, 00168, Lazio, Italy
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.