Textbook outcome of gastric cancer surgery and lymph node evaluation as its parameter to improve long-term survival

Textbook outcome (TO) is a short-term outcome that integrates postoperative outcomes to evaluate the quality of surgery. In terms of gastric cancer surgery, TO is mostly the results from Western countries and we wanted to analyse the results from Korea, where gastric cancer is prevalent and the effect on the long-term survival. Using DUCA’s parameters, we evaluated TO, 5-year overall survival and independent prognostic factors according to the TNM stage. TO was achieved in 74.6% patients. There were significant differences in the 5-year overall survival between the TO and non-TO groups regardless of stage. TO and ≥ 30 retrieved lymph nodes was an independent prognostic factor in stage II/III. We also evaluated the number of retrieved lymph nodes to assess the required number of lymph nodes for D2 dissection. The median number of retrieved lymph nodes increased depending on the stage, from 38 in stage IA. The median number of retrieved lymph nodes in distal and total gastrectomy for D2 lymph node dissection was 44 and 55 in stage II/III, respectively. Based on these results, evaluation of more than 30 lymph nodes should be considered to achieve optimal radical gastric cancer surgery.