Textbook outcome and long-term survival after pulmonary resection for non-small cell lung cancer: a retrospective cohort study
Issued Date
2026-12-01
Resource Type
eISSN
14777819
Scopus ID
2-s2.0-105029863271
Pubmed ID
41540440
Journal Title
World Journal of Surgical Oncology
Volume
24
Issue
1
Rights Holder(s)
SCOPUS
Bibliographic Citation
World Journal of Surgical Oncology Vol.24 No.1 (2026)
Suggested Citation
Raykateeraroj N., Chu F., Suh J.M., Petterlin L., Francis E., Zhao J., Ratnayakemudiyanselage P., Navaz F.A.P., Ker C.J., Roshanaei S., Botta H., Elias J., Ling E., Ma R., Barnett S.A., Knight S., Lee D.K., Weinberg L. Textbook outcome and long-term survival after pulmonary resection for non-small cell lung cancer: a retrospective cohort study. World Journal of Surgical Oncology Vol.24 No.1 (2026). doi:10.1186/s12957-026-04195-9 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/115160
Title
Textbook outcome and long-term survival after pulmonary resection for non-small cell lung cancer: a retrospective cohort study
Corresponding Author(s)
Other Contributor(s)
Abstract
Background: Textbook outcome is a composite measure reflecting an ideal perioperative course by integrating multiple care-quality indicators. While its use has been reported internationally for non-small cell lung cancer (NSCLC) resection, it has not previously been evaluated in the Australian setting. This study aimed to determine the proportion of patients achieving a textbook outcome after NSCLC resection, identify the components that most commonly prevented its attainment, and evaluate its association with long-term overall survival. Methods: A retrospective cohort study was conducted of adults undergoing lung resection for primary NSCLC at a tertiary Australian centre (2011–2023). Textbook outcome was defined according to the Dutch Lung Cancer Audit–Surgery criteria, requiring negative margins, complete lymph node dissection, absence of major complications, no 30-day mortality or reintervention, no prolonged ICU/high-dependency stay, no prolonged hospitalisation, and no readmission. Multivariable logistic regression identified predictors of textbook outcome, and Kaplan–Meier analysis was used to assess long-term survival. Results: Of 731 patients, 163 (22.3%) met all textbook outcome criteria. Failure to achieve the composite outcome was most commonly caused by incomplete lymph node dissection (67.6%), reintervention (22.5%), major complications (20.2%), or prolonged stay (13.2%). Male sex (OR 0.53, 95% CI 0.36–0.77) and open surgery (OR 0.54, 95% CI 0.35–0.83) were associated with lower odds of meeting the criteria, while carcinoid histology increased the odds (OR 1.91, 95% CI 1.04–3.45). Patients who met the textbook outcome criteria had higher survival (5-year: 89.7% vs. 70.8%; 10-year: 82.0% vs. 60.7%; log-rank p < 0.001). Conclusion: Textbook outcome was achieved in approximately one-fifth of patients and was strongly associated with improved long-term survival. Enhancing lymph node dissection and wider adoption of minimally invasive surgery may help increase textbook outcome rates and represents a potential focus for future quality-improvement initiatives. Trial registration: This study was retrospectively registered in the Australian-New Zealand Clinical Trials Registry (ACTRN12625000913471).