Minimally invasive colectomy May contribute to a better long-term prognosis for patients when a textbook outcome is not achieved.

[PURPOSE] Textbook outcome (TO) reflects ideal surgical and postoperative quality measures from the patient's perspective. Non-achievement of a TO has been linked to a poor prognosis after colorectal cancer surgery. Minimally invasive colectomy (MIC), being considerably less invasive than open colectomy (OC) may improve prognosis; however, its effect on the long-term prognosis of patients with non-achievement of a TO remains unclear. This study investigated the impact of TO achievement on prognosis after OC and MIC.

[METHODS] The subjects of this retrospective analysis were 256 patients who underwent OC and 472 patients who underwent MIC for colorectal cancer at Miyazaki Prefectural Nobeoka Hospital or Kumamoto University. TO was defined by five criteria: surgery within 6 weeks of diagnosis, radical resection, lymph node (LN) yield ≥ 12, no stoma, and no adverse outcomes. TO was achieved when all criteria were met; otherwise, the result was defined as non-TO (nTO). Both OC and MIC groups were stratified by TO status.

[RESULTS] TO achievement was significantly higher after MIC than after OC (39.0%, and 31.6%, respectively; p = 0.049). After OC, nTO patients had significantly worse 5-year overall survival than TO patients (log-rank p = 0.011). Multivariate analysis identified nTO as an independent risk factor for poor prognosis after OC [hazard ratio: 2.81; 95% confidence intervals (CI): 1.330-6.428; p = 0.0060]. In contrast, nTO had no significant impact on prognosis after MIC (log-rank p = 0.14).

[CONCLUSIONS] Non-achievement of a TO predicted poorer prognosis after OC but not MIC. The lower invasiveness of MIC may promote better long-term outcomes, even if a TO is not achieved.