“Textbook outcomes” in colorectal surgery (a systematic review)

OBJECTIVE: to analyze existing definitions of “textbook outcome” (TO) in colorectal cancer surgery and to justify the need for their standardization.

PATIENTS AND METHODS: a systematic review was conducted in accordance with the PRISMA guidelines. PubMed, the Cochrane Library, and eLIBRARY were searched for the period 2010-2025. Original studies evaluating TO in adult patients after surgical treatment for colorectal cancer were included. Study quality was assessed using the Newcastle-Ottawa scale.

RESULTS: sixteen studies (335,575 patients) were included. The rate of achieving TO ranged from 28.5% to 77.4%. Significant heterogeneity in TO definitions was identified. The most common components were R0 resection, lymph node dissection ≥ 12, absence of major complications (Clavien-Dindo ≥ III), readmissions, and mortality (30/90 days), as well as length of hospitalization (fixed values or 75th percentile). Achieving TO was associated with improved survival (a 40-55% reduction in the risk of death). Significant factors included surgical approach, ERAS, age, comorbidities, stage, neoadjuvant therapy, insurance type, and surgical volume.

CONCLUSION: TO is a valid tool for assessing the quality of surgical treatment of colorectal cancer associated with long-term survival. The lack of a unified definition limits the comparability of results. The proposed standardized definition (R0 resection, lymph node dissection ≥ 12, absence of major complications, 30-day mortality and readmissions, length of stay within the 75th percentile) can serve as the basis for international consensus.

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