Association between textbook outcomes of liver surgery (TOLS) and overall survival in gallbladder cancer patients treated with curative-intent resection: A multicenter study

Background This study investigated the relationship between textbook outcomes of liver surgery (TOLS) and overall survival (OS) in patients who underwent curative-intent resection of GBC. Method Patients with GBC who underwent curative-intent resection between 2014 and 2021 were selected from 16 hospitals. Patients were divided into either the TOLS group or the non-TOLS group according to whether TOLS were observed. Patients who died within 90 days of surgery were excluded prior to the survival analysis. Log-rank test was used to compare the difference in the OS rate between TOLS and non-TOLS groups. Univariate and multivariate analyses were performed using Cox regression analysis to identify factors independently associated with OS. Results A total of 913 patients were selected, 565 (61.9%) exhibited TOLS. The 5-year OS rate in the TOLS group was significantly higher than that in the non-TOLS group (45.4% vs. 21.9%; P<0.001). Multivariate Cox regression analysis confirmed TOLS, TB level> 54 µmol/ml, CEA level> 5 µg/ml, CA19-9 level> 37 U/L, poor differentiation, stages T2 and T3/4 according to the 8th edition AJCC T staging manual, N1 and N2 according to the 8th edition AJCC N staging manual, and adjuvant chemotherapy as independent risk factors that affect OS after curative-intent resection of GBC. Conclusion Among patients who undergo curative-intent resection of GBC, approximately 61.9% experience TOLS. TOLS are not only the optimal short-term outcome but also associated with long-term survival.