P1.201. Textbook Outcome After Oesophago-Gastric Cancer Surgery: Temporal Change Over 24 Years and Association With Survival

Abstract

Abstract Topic Esophageal Cancer: Surgical Treatment of Esophageal Cancer – early outcomes and complications Background Outcomes after oesophago-gastric cancer surgery have improved over the last two decades, but it is unclear whether this reflects fewer complications, improved surgery, or both. Textbook outcome (TO) captures complete tumour resection together with an uncomplicated postoperative course. We examined temporal changes in TO and its association with survival. Methods All patients undergoing curative-intent oesophagectomy or gastrectomy for malignancy between 2001 and 2025 in a high-volume UK unit were studied. TO required R0 resection, ≥15 lymph nodes examined, absence of major complications (Clavien–Dindo ≥3), no reintervention, no postoperative re-intubation, length of stay ≤21 days, and no in-hospital mortality. Temporal change in TO was assessed, and overall survival analysed using multivariable Cox regression adjusting for age, sex, co-morbidity, neoadjuvant therapy, procedure type, treatment era, and pathological stage. Results Among 1,640 resections with complete data (median age 69 years; median stay 13 days), TO occurred in 28.9%. Rates were similar after oesophagectomy (29.6%) and gastrectomy (25.7%). TO increased progressively across eras: 24.8% (2001–2005), 27.0% (2006–2010), 31.0% (2011–2015), 39.7% (2016–2020) and 44.8% 2021 to 2025. Patients achieving TO had improved overall survival after adjustment (HR 0.83, 95% CI 0.69–0.99; p=0.043). Conclusion Achievement of textbook outcome increased over time after oesophago-gastric resection. Patients achieving TO had longer survival after adjustment for stage and treatment factors. These findings indicate that improvements in peri-operative care and operative practice are associated with better survival.