PREOPERATIVE NEOADJUVANT TREATMENT’S EFFECT ON PROCESS PERFORMANCE IN VIDEO-ASSISTED PROCEDURES FOR RECTAL CANCER

Abstract

Textbook outcome is a quality indicator that includes the main postoperative outcomes, namely the absence of major complications, an R0 resection, and optimal length of hospitalisation. It has been suggested as an alternative to individual outcome parameters. This study aimed to assess the correlation between textbook outcome and neoadjuvant therapy, thus revealing the impact of NT on a surgical outcome.

Methods:  Patients with a minimally invasive rectal surgery from patients treated between January 2019 and June 2024, inclusive, were considered. The textbook outcome was considered to have a lack of major adverse events, the resection should be R0, at least twelve lymph nodes should be harvested, and the length of stay should not exceed the 75th percentile for the respective year. Logistic analyses were used to subrogate the association between NT and TO combined with a subgroup and stepwise analysis to identify potential modifying factors and highlight potential interaction effects. Results: 405 patients were analyzed; 207met TO criteria. NT is significantly associated with a lower probability of achieving TO. The odds ratio achieving TO were 0,37 (95% CI 0,21-0,65); p<0,001; a contrary robotic surgery (OR 2,84; 95% CI 1,92-5,11), a complete laparoscopic approach to surgery (OR 2,79; 95% 1,71-4,56), enhanced recovery protocol after surgery (OR 1,82; 95% 1,03-2,49) and stoma (OR= 1,87; 95% 1,18-2,96) show significant positive association with achieving TO. NT-induced morbidity of TO was significantly higher in patients with a long operation time, which suggested an interaction effect.

Conclusion: Neoadjuvant therapy correlated with lower rates of textbook outcomes, most notably in patients with extended operation times. Conversely, robotic and complete laparoscopic treatment, enhanced recovery, and stoma significantly influenced the TO probability.