# Textbook outcomes in oesophageal resections from an evolving thoracic surgical unit

## TL;DR

This study evaluates textbook outcomes in oesophageal cancer surgeries at a low-resource hospital in India, finding that one-third met quality benchmarks but lymph node yield remains a challenge.

## Contribution

The study applies the Dutch GI Cancer Audit's textbook outcome metric in a low-volume, resource-limited Indian surgical setting.

## Key findings

- Textbook outcomes were achieved in 34.1% of oesophageal resections.
- Complete resection was achieved in all patients, but optimal lymph node yield was met in only 61%.
- Perioperative mortality was 4.8%, with major morbidity in 17.1% of patients.

## Abstract

Textbook outcome (TO) is a composite metric of surgical quality. This study evaluated TO in oesophageal resections at a low-volume thoracic surgical unit in a Tier-2 city in India, assessing its applicability in a resource-constrained setting. This retrospective study included all patients with oesophageal cancer undergoing curative resection at our centre from 1 January 2020 to 31 December 2024. Patients were identified from a prospectively maintained surgical database and electronic medical records. Clinico-radiological, histopathological, and surgical outcomes were evaluated. TO was defined using the 2017 Dutch Upper Gastrointestinal (GI) Cancer Audit, comprising ten parameters, including complete resection, no major morbidity, and adequate lymph node yield. Among 41 patients, TO was achieved in 14 (34.1%). Major perioperative morbidity (Clavien-Dindo Grade ≥ II) occurred in 7 (17.1%) patients, with two (4.8%) perioperative deaths. Complete resection as per surgeon assessment was achieved in all cases (41/41, 100%), while optimal lymph node yield (≥ 15 nodes) was the most challenging parameter (25/41, 61%), followed by no 30-day readmission (34/41, 82.9%). TO was achieved in one-third of patients, comparable to international benchmarks, but optimal lymph node yield remains a challenge. TO is a useful quality assurance tool, though context-specific adaptations may enhance its relevance in India.