单一指标不足以反映胃癌患者治疗的多维和复杂的围手术期性质。有一个新开发的综合指标，称为教科书结果，反映了“理想”的手术结果。然而，关于胃癌患者教科书结果的长期预后的证据有限。因此，本研究旨在评估胃切除术后教科书结果与长期肿瘤预后之间的关联。总共纳入了 2004 年 1 月至 2017 年 12 月期间接受胃切除术的 2,658 名连续患者。主要终点是 5 年条件生存（如果患者在手术后的前 30 天存活）。教科书结果的定义为：取出≥15个淋巴结、pR0切除、术中完全可能治愈性切除、住院≤21天、无再次干预、无严重术后并发症、出院后≤30天无再入院、无计划外重症监护病房治疗，且无术后 30 天死亡率。进行多变量分析来评估教科书结果的调整预测因素。使用 Cox 回归分析来分析达到教科书结果参数与长期肿瘤预后之间的关系。 在本研究中，2,658 名患者中共有 1,770 名患者 (66.6%) 达到了所有教科书结果指标。 教科书结果组的 5 年条件总生存率高于非教科书结果组（64.7% vs 40.2%，P < .001）。具有教科书结果的患者的 5 年条件无病生存率明显优于没有教科书结果的患者（63.1% vs 37.6%，P < .001）。教科书结果与较长的 5 年条件总生存率和无病生存率独立相关（风险比分别为 0.494 [0.439-0.557] 和风险比 0.487 [0.433-0.547]）。达到教科书结果与改善长期生存密切相关。胃癌患者的长期肿瘤学预后，强调需要继续努力提高手术护理质量。版权所有 © 2024 Elsevier Inc. 保留所有权利。

A single metric does not sufficiently capture the multidimensional and complex perioperative nature of treatment for patients with gastric cancer. There is a newly developed composite indicator, called textbook outcome, that reflects the "ideal" surgical outcome. However, limited evidence exists for the long-term prognosis of textbook outcome in patients with gastric cancer. Thus, this study was aimed at assessing the association between textbook outcome and long-term oncologic prognosis after gastrectomy.In total, 2,658 consecutive patients who underwent gastrectomy between January 2004 and December 2017 were included. The primary endpoint was 5-year conditional survival (if the patient survived the first 30 days after surgery). Textbook outcome was defined as retrieved ≥15 lymph nodes, pR0 resection, complete-potentially curative resection during operation, hospitalization ≤21 days, no reinterventions, no severe postoperative complications, no hospital readmission ≤30 days after discharge, no unplanned intensive care unit treatment, and no 30-day postoperative mortality. Multivariable analysis was performed to evaluate the adjusted predictors of textbook outcome. A Cox regression analysis was used to analyze the relationship between achieving textbook outcome parameters and long-term oncologic prognosis.A total of 1,770 (66.6%) of the 2,658 patients achieved all textbook outcome metrics in this study. The textbook outcome group displayed a greater 5-year conditional overall survival than the nontextbook outcome group (64.7% vs 40.2%, P < .001). The 5-year conditional disease-free survival of the patients with textbook outcomes was strongly superior to that of the patients without textbook outcomes (63.1% vs 37.6%, P < .001). Textbook outcome was independently associated with longer 5-year conditional overall survival and disease-free survival (hazard ratio 0.494 [0.439-0.557] and hazard ratio 0.487 [0.433-0.547], respectively).Attaining textbook outcome is strongly related to an improved long-term oncologic prognosis for patients with gastric cancer, underscoring the need for continued efforts to enhance surgical care quality.Copyright © 2024 Elsevier Inc. All rights reserved.