Association of modified textbook outcome and overall survival after surgery for colorectal liver metastases: A nationwide analysis

Kelly R. Voigt, Michelle R. de Graaff*, Cornelis Verhoef, Geert Kazemier, Rutger J. Swijneburg, J. Sven D. Mieog, Wouter J.M. Derksen, Carlijn I. Buis, Paul D. Gobardhan, Marcel den Dulk, Ronald M. van Dam, Mike S.L. Liem, Wouter K.G. Leclercq, Koop Bosscha, Eric J.T. Belt, Maarten Vermaas, Niels F.M. Kok, Gijs A. Patijn, H. M. Marsman, Peter B. van den BoezemJoost M. Klaase, Dirk J. Grünhagen*, Dutch Hepato Biliary Audit Group

*Corresponding author for this work

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Textbook outcome (TO) represents a multidimensional quality measurement, encompassing the desirable short-term outcomes following surgery. This study aimed to investigate whether achieving TO after resection of colorectal liver metastases (CRLM) surgery is related to better overall survival (OS) in a national cohort. 


Data was retrieved from the Dutch Hepato Biliary Audit. A modified definition of TO (mTO) was used because readmissions were only recorded from 2019. mTO was achieved when no severe postoperative complications, mortality, prolonged length of hospital stay, occurred and when adequate surgical resection margins were obtained. To compare outcomes of patients with and without mTO and reduce baseline differences between both groups propensity score matching (PSM) was used for patients operated on between 2014 and 2018. 


Out of 6525 eligible patients, 81 % achieved mTO. For the cohort between 2014 and 2018, those achieving mTO had a 5-year OS of 46.7 % (CI 44.8–48.6) while non-mTO patients had a 5-year OS of 33.7 % (CI 29.8–38.2), p < 0.001. Not achieving mTO was associated with a worse OS (aHR 1.34 (95 % CI 1.17–1.53), p < 0.001. Median follow-up was 76 months., PSM assigned 519 patients to each group. In the PSM cohort patients achieving mTO, 5-year OS was 43.6 % (95 % CI 39.2–48.5) compared to 36.4 % (95 % CI 31.9–41.2) in patients who did not achieve mTO, p = 0.006. 


Achieving mTO is associated with improved long-term survival. This emphasizes the importance of optimising perioperative care and reducing postoperative complications in surgical treatment of CRLM.

Original languageEnglish
Article number107972
JournalEuropean Journal of Surgical Oncology
Issue number3
Publication statusPublished - Mar 2024

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