Abstract：
BACKGROUND: Textbook oncologic outcome (TOO) is a composite metric shown to correlate with improved survival after curative intent oncologic procedures. Despite increasing use among disciplines in surgical oncology, no consensus exists for its definition in cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).
METHODS: An international consensus-based study employed a Delphi methodology to achieve agreement. Fifty-four senior surgeons from the peritoneal surface malignancies field received a questionnaire comprising TOO parameters divided into 3 surgical domains: operative, short-term, and long-term postoperative outcomes. Two online meetings with participants defined the new criteria. Consensus was achieved when 75% of agreement rate was reached. Clinical data of patients who underwent CRS and HIPEC for colorectal peritoneal metastasis between 2010 and 2022 from 1 designated center (Sheba Medical Center) were collected, the consensus definition applied and outcomes analyzed.
RESULTS: Thirty-eight surgeons (70%) participated. Expert consensus TOO parameters for colorectal peritoneal metastasis CRS and HIPEC included the absence of unplanned reoperations during 30 days postoperation, absence of severe postoperative complications (Clavien-Dindo ≥III), absence of unplanned readmissions during 30 days postoperation, 90-day postoperative mortality, and absence of contraindications for chemotherapy within 12 weeks from operation, and included the achievement of complete cytoreduction (CC0). The study cohort consisted of 251 patients, and 151 (60%) met TOO criteria. Patients who achieved TOO had significantly better overall survival (median 67.5 months, 95% CI) vs patients who did not achieve TOO (median 44.6 months, 95% CI, p < 0.001) and significantly improved disease-free survival (median, 12 months, 95% CI, vs 9 months, 95% CI, p = 0.01).
CONCLUSIONS: Achievement of TOO as defined by consensus statement is associated with improved survival.
METHODS: An international consensus-based study employed a Delphi methodology to achieve agreement. Fifty-four senior surgeons from the peritoneal surface malignancies field received a questionnaire comprising TOO parameters divided into 3 surgical domains: operative, short-term, and long-term postoperative outcomes. Two online meetings with participants defined the new criteria. Consensus was achieved when 75% of agreement rate was reached. Clinical data of patients who underwent CRS and HIPEC for colorectal peritoneal metastasis between 2010 and 2022 from 1 designated center (Sheba Medical Center) were collected, the consensus definition applied and outcomes analyzed.
RESULTS: Thirty-eight surgeons (70%) participated. Expert consensus TOO parameters for colorectal peritoneal metastasis CRS and HIPEC included the absence of unplanned reoperations during 30 days postoperation, absence of severe postoperative complications (Clavien-Dindo ≥III), absence of unplanned readmissions during 30 days postoperation, 90-day postoperative mortality, and absence of contraindications for chemotherapy within 12 weeks from operation, and included the achievement of complete cytoreduction (CC0). The study cohort consisted of 251 patients, and 151 (60%) met TOO criteria. Patients who achieved TOO had significantly better overall survival (median 67.5 months, 95% CI) vs patients who did not achieve TOO (median 44.6 months, 95% CI, p < 0.001) and significantly improved disease-free survival (median, 12 months, 95% CI, vs 9 months, 95% CI, p = 0.01).
CONCLUSIONS: Achievement of TOO as defined by consensus statement is associated with improved survival.
摘要：
背景：教科书肿瘤学结果（TOO）是一个复合指标，显示与治愈性肿瘤学程序后生存率的提高相关。尽管外科肿瘤学学科的使用越来越多，其定义在细胞减灭术(CRS)和腹腔热灌注化疗(HIPEC)中尚无共识.
方法：一项基于国际共识的研究采用Delphi方法达成共识。来自腹膜表面恶性肿瘤领域的54名高级外科医生收到了一份问卷，该问卷由TOO参数组成，分为3个手术领域：手术，术后短期和长期结果。与与会者举行的两次在线会议定义了新标准。当达成75％的协议率时，就达成了共识。收集2010-2022年在一个指定中心（SMC）接受CRS/HIPEC治疗结直肠腹膜转移（CPM）的患者的临床资料，应用共识定义并分析结果。
结果：38名外科医生（70%）参加。CPM-CRS/HIPEC的专家共识TOO参数包括：手术后30天的计划外再手术，严重的术后并发症（Clavien-Dindo≥III），手术后30天内计划外再入院，术后90天死亡率，术后12周内化疗禁忌症，并包括实现完全细胞减少(CC-0)。研究队列包括251例患者;151例患者(60%)符合TOO标准。达到TOO的患者总生存期明显更好（中位数为67.5个月，CI95%）与未达到TOO的患者（中位数44.6个月，CI95%，p值<0.001)，并显著提高无病生存率(中位数，12个月,CI95%，vs.9个月,CI95%，p值=0.01)。
结论：达成共识声明所定义的TOO与生存率提高相关。
方法：一项基于国际共识的研究采用Delphi方法达成共识。来自腹膜表面恶性肿瘤领域的54名高级外科医生收到了一份问卷，该问卷由TOO参数组成，分为3个手术领域：手术，术后短期和长期结果。与与会者举行的两次在线会议定义了新标准。当达成75％的协议率时，就达成了共识。收集2010-2022年在一个指定中心（SMC）接受CRS/HIPEC治疗结直肠腹膜转移（CPM）的患者的临床资料，应用共识定义并分析结果。
结果：38名外科医生（70%）参加。CPM-CRS/HIPEC的专家共识TOO参数包括：手术后30天的计划外再手术，严重的术后并发症（Clavien-Dindo≥III），手术后30天内计划外再入院，术后90天死亡率，术后12周内化疗禁忌症，并包括实现完全细胞减少(CC-0)。研究队列包括251例患者;151例患者(60%)符合TOO标准。达到TOO的患者总生存期明显更好（中位数为67.5个月，CI95%）与未达到TOO的患者（中位数44.6个月，CI95%，p值<0.001)，并显著提高无病生存率(中位数，12个月,CI95%，vs.9个月,CI95%，p值=0.01)。
结论：达成共识声明所定义的TOO与生存率提高相关。
