Skip to main content
Download PDF

Textbook outcome in ovarian cancer and its impact on survival: comparative study

World Journal of Surgical Oncology volume 23, Article number: 32 (2025) Cite this article

Abstract

Introduction

Patients who achieve the textbook outcome (TO) present an uneventful postoperative course. Obtaining TO has also been related to better survival in oncological patients. Information about TO in patients with peritoneal carcinomatosis from ovarian cancer who undergo surgery is very scarce. Our objective was investigate TO in patients with carcinomatosis of ovarian origin who underwent interval surgery with or without HIPEC (TOOC) and its impact on survival.

Methods

A multicenter study was performed between 2010 and 2015. Inclusion criteria were > 18 years old, with ovarian cancer and peritoneal carcinomatosis, who underwent scheduled surgery after response to neoadjuvant therapy. The criteria to establish TOOC were no major complications, no mortality, non-prolonged stay (p75:10 days), complete cytoreduction (CC-0), and no readmission.

Results

365 patients were included, and TOOC was achieved in 204 (55.9%) patients. CC-0 cytoreduction was obtained in 312(85.5%). 7 patients (1.9%) died. 71 (19.5%) presented major complications (≥ IIIa). The readmission rate was 9.3%, and 24.9% of the patients presented a prolonged stay. The parameter with most significant negative impact on achieving TOOC was length of stay. Multivariate analysis confirmed postsurgical PCI, age, HIPEC, and time of surgery in minutes as an independent factor of TOOC. Survival analysis showed that patients who achieved TOOC had better overall survival (41 months (24.5– 67) versus 27 months (14-48.2) (p < 0.0001).

Conclusion

TO is an easy and valuable management tool for evaluating and comparing results obtained at different centers after surgery for peritoneal carcinomatosis of locally advanced ovarian cancer. Achieving TOOC benefits overall survival.

Highlights

  • TO is a multidimensional measure that gathers relevant postoperative parameters, permitting the comparison of results between different centers.

  • Textbook outcome is and independent factor for survival in every PCI.

  • Archieve Textbook outcome in ovarian carcinomatosis has a positive impact on survival.

Introduction

The quality of cancer surgery is assessed by measuring numerous parameters related to the patient’s or tumor’s characteristics, postoperative morbidity, and disease-free survival [1]. In surgery, benchmarking strategies have evolved considerably over recent decades, and the appearance of pathology-specific benchmarks is also becoming increasingly more common [2].

In 2013, the first definition of textbook outcome (TO) appeared, gathering several benchmarks to reflect the ideal result of a surgical procedure with an uneventful peri- and postoperative course and excellent oncological results [3]. Length of hospital stay, mortality, readmission, peri-operative complications, stoma preparation, readmission to the ICU, and complete resection (R0) were used to define TO in colorectal cancer surgery. Since then, interest in applying this new quality tool has exponentially increased, with emerging definitions of TO in almost all surgical areas, such as hepatopancreatobiliary, esophagogastric, and bariatric surgery [4,5,6].

Ovarian cancer of epithelial origin is the sixth most common cancer in women and the primary cancer-related death in this population. Due to its slow growth, most patients remain asymptomatic, and 80% debut with ascites and peritoneal carcinomatosis. The standard treatment for the initial management of advanced tubo-ovarian carcinoma is primary cytoreductive surgery (PCS) or, in those not considered suitable for upfront surgery, NACT followed by intervalic surgery. Bevacizumab and as first- and second-line treatment for advanced epithelial ovarian, fallopian tube, and primary peritoneal cancers. Its use in OC is primarily based on the positive results of some randomized clinical trials showing improved survival rates with the addition of bevacizumab to standard first line chemotherapeutic drugs, mainly in high-risk patients and to second-line treatment both in platinum sensitive and platinum-resistant disease [7,8,9]. For patients with FIGO stage IIIc, when a complete cytoreduction cannot be achieved, neoadjuvant therapy followed by CC-0 cytoreductive surgery (CRS), with or without hyperthermic intraperitoneal chemotherapy (HIPEC), has proven to be the best treatment providing the best long-term survival rates [8, 9]. Nevertheless, an appropriate cytoreductive surgery may require a high level of specialization, being associated with high morbidity rates, around 20 to 60%, and mortality rates between 5 and 10% [4, 10]. Definition of benchmarks in the field of peritoneal carcinomatosis remains troublesome because a wide range of therapeutic scenarios is possible depending on the type of tumor or which protocol of HIPEC was used. This fact means that the results of the published studies vary widely, and it is not easy to establish clear follow-up guidelines [11, 12]. Only two studies have assessed the TO in ovarian peritoneal carcinomatosis by applying (using) different criteria or analyzing various types of tumors [13, 14].

The present study aims to assess the TO in a series of patients with peritoneal carcinomatosis of ovarian origin undergoing interval CRS with or without HIPEC and to evaluate the impact of TO on overall survival.

Materials and methods

Study design and setting

A multicenter retrospective observational study was performed between 2010 and 2023 from a prospective database on all patients with peritoneal carcinomatosis of ovarian origin undergoing or that underwent interval CRS (with or without HIPEC) and subsequent adjuvant treatment from 3 referral centers for the treatment of peritoneal carcinomatosis.

Each center’s multidisciplinary clinical committee decided whether to administer neoadjuvant therapy or not to specific patients. The inclusion criteria were patients over 18 years of age, with peritoneal carcinomatosis from ovarian origin, who underwent scheduled surgery with curative intent after response to neoadjuvant therapy. The study followed the guidelines for Strenghtening the Reporting of Observational Studies in Epidemiology (STROBE) [15]. The study is registered in www.researchregistry.com/with the unique identification number (UIN) 10,306. The medical ethics committee judged that no informed consent from the patients was necessary because of the observational nature of the study without additional burden for the patient. Ethical approval for this study (Ref. CEIm: PI2023-070) was provided by the ethical Committee of Alicante, ISABIAL institute on 11 September 2023. Ethical committee waived informed consent due to retrospective nature and entailed no risk for patients. Planning and analysis of the study was carries out according to the STROCCS Reporting Guidelines for Cohort Studies [16]. Data are in a repository and could be requested to main author under are justified application.

Patients

Patient characteristics, tumor, and treatment data were obtained from a database created using written and electronic medical records to carry out the study. Comorbidity was evaluated according to the ASA score and the Charlson index [17, 18]. The tumor stage was classified according to FIGO classification [19]. The postoperative complications were collected according to the Clavien-Dindo classification [20]. Postoperative complications ≥ IIIa were considered major complications.

Textbook outcome

Based on the definitions of TO applied in other surgical areas and in agreement with Algera et al., [14] the criteria used to establish TO from ovarian origin (TOOC) were the following: (i) no Clavien-Dindo complications ≥ IIIa, (ii) absence of mortality at 90 postoperative days, (iii) non-prolonged length of stay (LOS) which was established according to the p75 of the series, (iv) achieving complete cytoreduction (CC-0), and (v) no re-admission within 30 days. Overall survival (OS) was calculated from surgery to death due to any cause or the date of the last follow-up.

Statistical analysis

Quantitative variables, median, and interquartile range (IQR) were determined; variables were compared using the Chi-squared and continuous variables with the non-parametric Mann-Whitney U test. Patient characteristics, tumor, histology, and treatment were compared between patients who achieved TOOC and patients who did not. The Kaplan-Meier curves and log-rank test were used to compare the survival of patients with or without TOOC. Logistic regression analysis evaluated the association of different factors affecting TOOC achievement. P value < 0.05 was considered statistically significant. The study was performed with SPSS v.25®.

Results

Textbook achieved parameters

A total of 365 patients were included. Complete CC-0 cytoreduction was achieved in 312 (85.5%). Seven patients (1.9%) died within 90 days after CRS. Seventy-one patients (19.5%) presented major complications. The 30-day readmission rate was 9.3%. The prolonged median length of hospital stay (LOS) was ten days, and 75.1% of the patients did not surpass it. Calculating the cumulative incidence of all the parameters that comprise TOOC, 204 patients (55.9%) achieved it. The parameter with the most significant negative impact on achieving TOOC was the length of stay, followed by major complications, incomplete cytoreduction, and readmissions. Mortality was the less frequent parameter that predicted the achievement of TOOC (Fig. 1).

Fig. 1
figure 1

Textbook outcome in ovarian carcinomatosis. (TOOC)

Full size image

Comparison of TOOC and non-TOOC groups

Comparison of the TOOC and non-TOOC groups revealed less median age (58 vs. 64, shorter surgical time in minutes 300 vs. 350, lower preoperative levels of CA125 (31 vs. 53), and lower levels of He4 (71 vs. 136), C-reactive protein (CRP) levels at 3postoperative day (63.5 vs. 124), age-adjusted scores on the Charlson scale, and peritoneal cancer index (PCI) (6 vs. 15). However, there were no significant differences in BMI, presurgical hemoglobin, leukocytes, lymphocytes, platelets, or CEA levels. There were also no differences in tumor histology (defined as high-grade in 91.8% of patients), the type of drug used for the HIPEC procedure, or surgical wound infection. (Table 1)

Table 1 Characteristics of patients who achieve TO versus non-TO
Full size table

Regarding surgical factors, the patients who achieved the TOOC had fewer intestinal resections (41.9% versus 21.9%) and fewer anastomoses (42.5%, only one). HIPEC was administered more often to patients in the TOOC group (48.2%) than to patients who did not have it (34.5%). As was expected, the TOOC group presented fewer overall medical complications and lower rates of surgical complications (both major and minor), including less anastomotic leakage (0.0% vs. 1.4%) and postsurgical ileus (1.9% vs. 4.4%). Central venous catheter infection was more frequent in the non-TOOC group. Adjuvant chemotherapy was initiated earlier in the TOOC group (six versus four weeks) p < 0.0001).

Univariant and multivariant analysis

The univariate analysis showed age, shorter surgical time, and the addition of HIPEC as independent factors associated with the achievement of TOOC, as well as lower PCI and fewer intestinal resections and anastomoses. Restart chemotherapy after surgery was earlier in the TOOC group. Other independent factors for achieving TOOC were the presence of postsurgical paralytic ileus and overall medical and surgical complications. The multivariate analysis confirmed lower age, lower PCI, administration of HIPEC, and shorter surgical time as predictors of the achievement of TOOC. Table 2 shows the results of the univariate and multivariate analyses.

Table 2 Univariant and multivariant analysis of independent factors for achieve TOOC
Full size table

Survival analysis

The survival analysis showed a better median overall survival in patients who achieved TOOC (median 41 versus 27 months) (log-rank p < 0.0001). Figure 2 shows the survival of the two groups. Finally, a survival analysis stratifying by PCI (< 10;10–20;>20) and TOOC was carried out; the patients who reached the TOOC patients showed significantly longer overall survival in all PCI categories. These data are provided in Supplementary File 1.

Fig. 2
figure 2

Kalpan- Maier curve for textbook outcome in Ovarian Carcinomatosis (TOOC)

Full size image

Discussion

TO is a multidimensional measure that gathers relevant postoperative parameters, permitting the comparison of results between different centers. In this study, we recorded a TOOC of 55.9%, which is very similar to the 54% published in a study from the Netherlands [16]. However, we included readmission as an additional parameter omitted in that study. The decision to do so is debatable since the readmission rate is often related to whether discharges are made early. However, including readmissions in the assessment of TOOC is an important measure of quality control since most readmissions are associated with complications, and initially, including these patients as TOOC when they were not, would have introduced a bias in the TOOC assessment. If we had not included this parameter, our TOOC rate would have been 58.6%.

Another distinctive feature of our study is assessing postoperative mortality at 90 days. Several publications support the mortality measurement to be performed at 90 days because the mortality rate may double if only 30 days or in-hospital mortality is used [19], and this fact may explain why our mortality rate was more than twice that previously reported (0.8% versus 1.9%) [16]. Both mortality rates are considered within the published quality standards for peritoneal carcinomatosis (< 5% 30-day mortality) [12, 13]. The main reason for the lower rate of TOOC achieved in our study was the prolonged stay, which in our research was ten days, coinciding with the cut-off point applied previously [16]; however, those authors did not calculate it using the p75 but considered that stays > 10 days reflected a delay in the start of adjuvant treatment after surgery, an important prognostic factor for survival.

Likewise, as in previous publications [16], we did not include the time until the restart of chemotherapy < 6 weeks in our definition of TOOC. However, the time to restart adjuvant chemotherapy was also significant, suggesting that adjuvant chemotherapy should probably be added for TOOC. Numerous publications that have associated this issue with better disease control, lower recurrence rates, and longer disease-free time and survival strengthen this approach [21, 22].

In our study, lower age, and low PCI (< 10), shorter time to surgery, and addition of HIPEC were predictive of the achievement of TOOC after the multivariate analysis. The Netherlands´ study only found age < 70 years to be a significant factor in failing to obtain the TOOC [16]. In our study, age was an independent factor for TOOC in the multivariate analysis. This data agrees with other studies in which increasing age is associated with a reduction in TO [23, 24] PCI is associated with a higher rate of TOOC achievement greeted achievement of TOOC. This is probably because the higher the PCI leads to an increased greater number of visceral resections and anastomoses, and the higher the postoperative morbidity rates [25,26,27].

Some clinical trials show that the use of HIPEC during the interval cytoreduction to treat patients with ovarian cancer after neoadjuvant therapy and cytoreduction plays a role in increasing improved survival in these patients in clinical trials and should be considered in the first surgery of patients with ovarian cancer with peritoneal dissemination treated with neoadjuvant systemic chemotherapy [10, 11, 28]. In the multivariate analysis, patients who received HIPEC were significantly more likely to achieve the TOOC than those who did not in the multivariate analysis. Although HIPEC is associated with nephrotoxicity, it does not increase the rest of the complications. This result is consistent with other studies that have demonstrated the safety of HIPEC and its low impact on postoperative morbidity [29,30,31].

As regards survival, patients who achieved TOOC survived a median of 14 months longer. The two curves remained separated from the beginning, and although the benefit was constant throughout the follow-up period, it was most remarkable for long-term survival (which is where the curves separate the most). These findings agree with other TO series, which have observed a direct and significant relationship between TO and increased survival [32,33,34,35,36,37,38,39,40]. A fact that reinforces and increases the value of achieving TOOC on survival is that, regardless of the patient’s surgical PCI, in all groups, the achievement of TOOC was associated with a statistically significant survival benefit. The two previously published series did not include the relationship between PCI and TO, so we could not compare them with our results.

Our study presented certain limitations. We should mention the retrospective observational nature of the data, with the possible biases that this approach entails. We did not include the time to restart chemotherapy after surgery as a TOOC parameter and the scarce of literature of TO in carcinomatosis. On the other hand, the study has specific strengths, such as novelty, its multicenter design in referral carcinomatosis centers, prospective databases, and long follow-up periods.

In conclusion, the TOOC is a valuable tool to compare the results obtained in patients with peritoneal carcinomatosis of ovarian origin undergoing interval surgery at different centers. The achievement of TOOC has a positive impact on survival.

Data availability

No datasets were generated or analysed during the current study.

Abbreviations

TO:

Textbook outcome

ICU:

Intensive care unit

CRS:

Cytoreductive surgery

HIPEC:

Hyperthermic intraperitoneal chemotherapy

ASA score:

American society of anesthesiologist

TOOC:

Textbook outcome ovarian cancer

LOS:

Length of stay

CC-0:

Complete cytoreduction

OS:

Overall survival

IQR:

Interquartile range

CRP:

C-reactive protein

PCI:

Peritoneal cancer index

BMI:

Body mass index

STROBE:

For strenghtening the reporting of observational studies in epidemiology

References

  1. Aranaz JM, Moya C. Patient safety and health care quality. Rev Calid Asist. 2011;26(6):331–2.

    Article  CAS  PubMed  Google Scholar 

  2. Ettorchi -Tardy A, Levif M, Michel P, Benchmarking. A method for continuous quality improvement in health. Healthc Policy. 2012;7(4):101–19.

    Google Scholar 

  3. Kolfschoten NE, Kievit J, Gooiker GA, Van Leersum NJ, Snijders HS, Eddes EH et al. Focusing on desired outcomes of care after colon cancer resections; Hospital variations in textbook outcome. Eur J Surg Oncol. 2013;39(2):156–63. Available from: https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.ejso.2012.10.007

  4. Busweiler LAD, Schouwenburg MG, van Berge Henegouwen MI, Kolfschoten NE, de Jong PC, Rozema T, et al. Textbook outcome as a composite measure in oesophagogastric cancer surgery. Br J Surg. 2017;104(6):742–50.

    Article  CAS  PubMed  Google Scholar 

  5. Carbonell-Morote S, Ortiz-Sebastián S, Estrada-Caballero JL, Gracia-Alegria E, Ruiz de la Cuesta Tapia E, Villodre C et al. Textbook Outcome in Bariatric Surgery: Evolution During 15 Years in a Referral Center. J Gastrointest Surg. 2023;27(8):1578–86. Available from: https://doiorg.publicaciones.saludcastillayleon.es/10.1007/s11605-023-05690-0

  6. Mehta R, Paredes AZ, Tsilimigras DI, Moro A, Sahara K, Farooq A et al. Influence of hospital teaching status on the chance to achieve a textbook outcome after hepatopancreatic surgery for cancer among Medicare beneficiaries. Surg (United States). 2020;168(1):92–100. Available from: https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.surg.2020.02.024

  7. Ledermann JA, Matias-Guiu X, Amant F, Concin N, Davidson B, Fotopoulou C et al. ESGO–ESMO–ESP consensus conference recommendations on ovarian cancer: pathology and molecular biology and early, advanced and recurrent disease. Ann Oncol. 2024;35(3):248–66. Available from: https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.annonc.2023.11.015

  8. Musella A, Vertechy L, Romito A, Marchetti C, Giannini A, Sciuga V, et al. Bevacizumab in ovarian cancer: state of the art and unanswered questions. Chemotherapy. 2016;62(2):111–20.

    Article  PubMed  Google Scholar 

  9. van Baal JOAM, van Noorden CJF, Nieuwland R, Van de Vijver KK, Sturk A, van Driel WJ, et al. Development of peritoneal carcinomatosis in epithelial ovarian Cancer: a review. J Histochem Cytochem. 2018;66(2):67–83.

    Article  PubMed  Google Scholar 

  10. van Driel WJ, Koole SN, Sikorska K, van Schagen JH, Schreuder HWR, Hermans RHM, et al. Hyperthermic Intraperitoneal Chemotherapy in Ovarian Cancer. N Engl J Med. 2018;378(3):230–40.

    Article  PubMed  Google Scholar 

  11. Antonio CCP, Francisco-Cristobal MC, Alida GG, Susana SG, Israel M, Rafael M et al. Upfront citorreduction and hyperthermic intraperitoneal chemotherapy with paclitaxel in patients with stage III-C serous epithelial ovarian cancer. Clin Exp Metastasis. 2019;(0123456789):3–10. Available from: https://doiorg.publicaciones.saludcastillayleon.es/10.1007/s10585-019-10010-5

  12. Foster JM, Sleightholm R, Patel A, Shostrom V, Hall B, Neilsen B, et al. Morbidity and mortality rates following cytoreductive surgery combined with Hyperthermic Intraperitoneal Chemotherapy compared with other High-Risk Surgical Oncology procedures. JAMA Netw Open. 2019;2(1):1–12.

    Article  Google Scholar 

  13. Plana A, Izquierdo FJ, Schuitevoerder D, Abbott DE, Abdel-Misih S, Ahrendt SA, et al. The Chicago Consensus on peritoneal surface malignancies: standards. Cancer. 2020;126(11):2516–24.

    Article  Google Scholar 

  14. Liu JB, Schuitevoerder D, Vining CC, Berger Y, Turaga KK, Eng OS. Benchmarking Perioperative Outcomes of Cytoreductive Surgery for Cancer: Implications for Quality Measurement. Ann Surg Oncol. 2020;27(13):5039–46. Available from: https://doiorg.publicaciones.saludcastillayleon.es/10.1245/s10434-020-08815-w

  15. Wiseman JT, Abdel-Misih S, Beal EW, Zaidi MY, Staley CA, Grotz T et al. A multi-institutional analysis of Textbook Outcomes among patients undergoing cytoreductive surgery for peritoneal surface malignancies. Surg Oncol. 2021;37(June 2020):101492. Available from: https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.suronc.2020.11.006

  16. Algera MD, Slangen BFM, van Driel WJ, Wouters MWJM, Kruitwagen RFPM. Textbook outcome as a composite outcome measure to compare hospital performances regarding cytoreductive surgery for ovarian cancer: A nationwide population-based study. Gynecol Oncol. 2023;174:89–97. Available from: https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.ygyno.2023.04.021

  17. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies. Int J Surg. 2014;12(12):1495–9. Available from: https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.ijsu.2014.07.013

  18. Mathew G, Agha R, Albrecht J, Goel P, Mukherjee I, Pai P et al. STROCSS 2021: Strengthening the reporting of cohort, cross-sectional and case-control studies in surgery. Int J Surg. 2021 Dec 1 [cited 2023 Apr 6];96. Available from: https://pubmed.ncbi.nlm.nih.gov/34774726/

  19. Doyle DJ, Garmon EH. American Society of Anesthesiologists Classification (ASA Class). StatPearls. StatPearls Publishing; 2018 [cited 2021 Jun 18]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28722969

  20. Charlson M, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index. J Clin Epidemiol. 1994 [cited 2021 Jun 18];47(11):1245–51. Available from: https://pubmed.ncbi.nlm.nih.gov/7722560/

  21. Prat J, Committee F. International Journal of Gynecology and Obstetrics Staging classi fi cation for cancer of the ovary, fallopian tube, and peritoneum ☆. Int J Gynecol Obstet. 2014;124(1):1–5. Available from: https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.ijgo.2013.10.001

  22. Clavien PA, Barkun J, De Oliveira ML, Vauthey JN, Dindo D, Schulick RD et al. The clavien-dindo classification of surgical complications: Five-year experience. Vol. 250, Annals of Surgery. Ann Surg; 2009 [cited 2021 Jun 18]. pp. 187–96. Available from: https://pubmed.ncbi.nlm.nih.gov/19638912/

  23. Busweiler LAD, Jeremiasen M, Wijnhoven BPL, Lindblad M, Lundell L, van de Velde CJH, et al. International benchmarking in oesophageal and gastric cancer surgery. BJS open. 2019;3(1):62–73.

    Article  CAS  PubMed  Google Scholar 

  24. Rocher G, Gaillard T, Uzan C, Collinet P, Bolze PA, Ballester M, et al. Does time-to-chemotherapy after primary complete macroscopic cytoreductive surgery influence prognosis for patients with epithelial ovarian cancer? A study of the francogyn group. J Clin Med. 2021;10(5):1–11.

    Article  Google Scholar 

  25. Lydiksen L, Jensen-Fangel S, Blaakaer J. Is it possible to define an optimal time for chemotherapy after surgery for ovarian cancer? Gynecol Oncol. 2014;133(3):454–9. Available from: https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.ygyno.2014.04.004

  26. Sędłak K, Rawicz-Pruszyński K, Mlak R, Gęca K, Skórzewska M, Pelc Z, et al. Union is strength: Textbook outcome with perioperative chemotherapy compliance decreases the risk of death in advanced gastric cancer patients. Eur J Surg Oncol. 2022;48(2):356–61.

    Article  PubMed  Google Scholar 

  27. Wu Y, Peng B, Liu J, Yin X, Tan Z, Liu R, et al. Textbook outcome as a composite outcome measure in laparoscopic pancreaticoduodenectomy: a multicenter retrospective cohort study. Int J Surg. 2023;109(3):374–82.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Gasimli K, Braicu EI, Richter R, Chekerov R, Sehouli J. Prognostic and predictive value of the Peritoneal Cancer Index in Primary Advanced Epithelial Ovarian Cancer patients after complete cytoreductive surgery: study of Tumor Bank Ovarian Cancer. Ann Surg Oncol. 2015;22(8):2729–37.

    Article  PubMed  Google Scholar 

  29. Llueca A, Escrig J, Serra-Rubert A, Gomez-Quiles L, Rivadulla I, Játiva-Porcar R, et al. Prognostic value of peritoneal cancer index in primary advanced ovarian cancer. Eur J Surg Oncol. 2018;44(1):163–9.

    Article  PubMed  Google Scholar 

  30. Elzarkaa AA, Shaalan W, Elemam D, Mansour H, Melis M, Malik E, et al. Peritoneal cancer index as a predictor of survival in advanced stage serous epithelial ovarian cancer: a prospective study. J Gynecol Oncol. 2018;29(4):1–10.

    Article  Google Scholar 

  31. Llueca A, Ibañez MV, Cascales P, Gil-Moreno A, Bebia V, Ponce J et al. Neoadjuvant chemotherapy plus interval cytoreductive surgery with or without Hyperthermic Intraperitoneal Chemotherapy (NIHIPEC) in the treatment of Advanced Ovarian Cancer: a multicentric propensity score study. Cancers (Basel). 2023;15(17).

  32. Samoylovich A, Jennings B, Shannon C, Coward JI, Lourie R, Riordan J, et al. Safety and feasibility of hyperthermic intraperitoneal chemotherapy during interval cytoreductive surgery in patients with advanced high-grade serous ovarian, fallopian tube, peritoneal cancer in an Australian context. Aust New Zeal J Obstet Gynaecol. 2023;63(5):702–8.

    Article  Google Scholar 

  33. Fornasiero M, Geropoulos G, Kechagias KS, Psarras K, Katsikas Triantafyllidis K, Giannos P et al. Anastomotic leak in ovarian Cancer cytoreduction surgery: a systematic review and Meta-analysis. Cancers (Basel). 2022;14(21).

  34. Della Corte L, Conte C, Palumbo M, Guerra S, Colacurci D, Riemma G et al. Hyperthermic Intraperitoneal Chemotherapy (HIPEC): New approaches and controversies on the treatment of Advanced epithelial ovarian Cancer—systematic review and Meta-analysis. J Clin Med. 2023;12(22).

  35. Kulshrestha S, Bunn C, Patel PM, Sweigert PJ, Eguia E, Pawlik TM et al. Textbook oncologic outcome is associated with increased overall survival after esophagectomy. Surg (United States). 2020;168(5):953–61. Available from: https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.surg.2020.05.038

  36. Carbonell Morote S, Gracia Alegría E, Ruiz de la Cuesta Tapia E, Llopis Torremocha C, Ortiz Sebastián S, Estrada Caballero JL et al. Textbook outcome en cirugía gástrica oncológica, ¿qué implicaciones tiene sobre la supervivencia? Cirugía Española. 2021 Oct [cited 2022 Mar 31]; Available from: https://www.elsevier.es/es-revista-cirugia-espanola-36-avance-resumen-textbook-outcome-cirugia-gastrica-oncologica-S0009739X2100302X

  37. Roh CK, Lee S, Son SY, Hur H, Han SU. Textbook outcome and survival of robotic versus laparoscopic total gastrectomy for gastric cancer: a propensity score matched cohort study. Sci Rep. 2021;(0123456789):1–11. Available from: https://doiorg.publicaciones.saludcastillayleon.es/10.1038/s41598-021-95017-3

  38. Kalff MC, Vesseur I, Eshuis WJ, Heineman DJ, Daams F, van der Peet DL et al. The Association of Textbook Outcome And Long-Term Survival After Esophagectomy for Esophageal Cancer. Ann Thorac Surg. 2020; Available from: https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.athoracsur.2020.09.035

  39. Cibulas MA, Avila A, Mahendra AM, Samuels SK, Gannon CJ, Llaguna OH. Impact of Textbook Oncologic Outcome Attainment on Survival After Gastrectomy: A Review of the National Cancer Database. Ann Surg Oncol. 2022 Dec 1 [cited 2022 Dec 8];29(13):8239–48. Available from: https://pubmed.ncbi.nlm.nih.gov/35974232/

  40. Carbonell-Morote S, Yang H-K, Lacueva J, Jesús Rubio-García J, Alacan-Friedrich L, Fierley L et al. Textbook outcome in oncological gastric surgery: a systematic review and call for an international consensus. World J Surg Oncol. 2023 [cited 2024 Feb 13];21:288. Available from: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12957-023-03166-8

Download references

Acknowledgements

No

Funding

Not applicable because no funding.

Author information

Author notes

  1. Silvia Carbonell-Morote and Alvaro Arjona-Sánchez Co-shared first authorship.

  2. Francisco Javier Lacueva and José Manuel Ramia Co-shared senior authorship.

Authors and Affiliations

  1. Universidad Miguel Hernández, Alicante, Spain

    Silvia Carbonell-Morote, Francisco Javier Lacueva & José Manuel Ramia

  2. Instituto de investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain

    Silvia Carbonell-Morote & José Manuel Ramia

  3. Hospital Universitario Reina Sofía Córdoba, Córdoba, Spain

    Alvaro Arjona-Sánchez & Gonzalo Gomez-Dueñas

  4. Peritoneal Carcinomatosis unit Department of Surgery, Hospital Universitario Virgen De la Arrixaca, Murcia, Spain

    Pedro Antonio Cascales-Campos, Alida González-Gil & Elena Gil-Gómez

  5. Universidad de Murcia, Carretera del Palmar S/N, 30123 El Palmar, Murcia, Spain

    Pedro Antonio Cascales-Campos

  6. Hospital General Universitario de Elche, Alicante, Spain

    Iban Caravaca-García, Veronica Aranaz & Francisco Javier Lacueva

Authors
  1. Silvia Carbonell-Morote
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Alvaro Arjona-Sánchez
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. Pedro Antonio Cascales-Campos
    View author publications

    You can also search for this author inPubMed Google Scholar

  4. Alida González-Gil
    View author publications

    You can also search for this author inPubMed Google Scholar

  5. Gonzalo Gomez-Dueñas
    View author publications

    You can also search for this author inPubMed Google Scholar

  6. Elena Gil-Gómez
    View author publications

    You can also search for this author inPubMed Google Scholar

  7. Iban Caravaca-García
    View author publications

    You can also search for this author inPubMed Google Scholar

  8. Veronica Aranaz
    View author publications

    You can also search for this author inPubMed Google Scholar

  9. Francisco Javier Lacueva
    View author publications

    You can also search for this author inPubMed Google Scholar

  10. José Manuel Ramia
    View author publications

    You can also search for this author inPubMed Google Scholar

Contributions

Role Definition Conceptualization CARBONELL, ARJONA, CASCALES, LACUEVA, RAMIA; Data curation SILVIA CARBONELL-MOROTE; ALIDA GONZÁLEZ GIL; GONZALO GÓMEZ DUEÑAS; ELENA GIL GÓMEZ; IBAN CARAVACA; VERONICA ARANAZ; Formal analysis CARBONELLFunding acquisition NO FUNDS; Investigation SILVIA CARBONELL-MOROTE; ALIDA GONZÁLEZ GIL; GONZALO GÓMEZ DUEÑAS; ELENA GIL GÓMEZ; IBAN CARAVACA; VERONICA ARANAZ; Methodology CARBONELL, RAMIA; Project administration CARBONELL, RAMIA; Resources Software CARBONELL; Supervision CARBONELL, RAMIA; Validation CARBONELL, ARJONA, CASCALES, LACUEVA, RAMIA; Visualization CARBONELL, RAMIA; Writing – original draft CARBONELL; Writing – review & editing CARBONELL, ARJONA, CASCALES, LACUEVA, RAMIA.

Corresponding author

Correspondence to Pedro Antonio Cascales-Campos.

Ethics declarations

Ethics approval and consent to participate

Study approved Ethics Committee of Hospital General Universitario Dr. Balmis (Ref. CEIm: PI2023-070). The study followed the guidelines for Strenghtening the Reporting of Observational Studies in Epidemiology (STROBE). The study is registered in www.researchregistry.com/with the unique identification number (UIN) 10,306. The medical ethics committee judged that no informed consent from the patients was necessary because of the observational nature of the study without additional burden for the patient. Including the waiver of informed consent and consent for participate due the retrospective nature of the study, entailed no risk. (Page 7).

Consent for publication

Not applicable. Waived for ethics Committee (Page 7).

Provenance and peer review not commissioned, externally peer-reviewed.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Material 1

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Carbonell-Morote, S., Arjona-Sánchez, A., Cascales-Campos, P.A. et al. Textbook outcome in ovarian cancer and its impact on survival: comparative study. World J Surg Onc 23, 32 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12957-025-03686-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12957-025-03686-5

Keywords

World Journal of Surgical Oncology

ISSN: 1477-7819

Contact us