Textbook outcomes in the liver-first approach for colorectal liver metastases: prospective multicentre analysis

Abstract

Textbook outcome is a valuable tool for assessing surgical outcomes. The aim of this study was to analyse textbook-outcome rates in the prospective Spanish National Registry of the Liver-First Approach(RENACI Project)and the factors influencing textbook-outcome achievement. Additionally, a model for assessing a procedure-specific textbook outcome for the liver-first approach was proposed. Methods A retrospective analysis of a prospective and multicentre database that included consecutive patients with colorectal cancers and synchronous liver metastases who underwent a liver-first approach between June2019 and August2020was performed. Two types of textbook outcome were measured:classic textbook outcome and liver-first-approach-specific textbook outcome(which included negative margins, no perioperative transfusion, no postoperative major surgical complications, no prolonged length of hospital stay, no readmissions, no mortality, and full treatment completion).The primary endpoint was textbook-outcome rate for a liver-first approach at 90 days. Results A total of 149 patients were included in the analysis. Classic and liver-first-approach-specific textbook-outcome rates were 71.8%(107 patients) and 46%(69 patients) respectively. Factors significantly associated with liver-first-approach-specific textbook-outcome achievement in the multivariable analysis were the number of metastases (OR 0.82 (95% c.i. 0.73 to 0.92);P= 0.001) and intraoperative blood loss (OR 0.99 (95% c.i. 0.99 to 1.00);P=0.007). Prolonged length of hospital stay(33 patients,41%),positive margins(31 patients, 39%),perioperative transfusion(27 patients, 34%),and no full treatment completion(18 patients, 23%) were the items that most frequently prevented liver-first-approach-specific textbook-outcome achievement. Conclusion Liver-first-approach-specific textbook outcome is a promising tool for measuring the quality of care when using the liver-first approach for synchronous colorectal liver metastases.