International Delphi consensus to define textbook outcome parameters for oncological gastrectomy (togs project).

BACKGROUND: Textbook Outcome (TO) is a quality indicator representing the ideal surgical postoperative course. The lack of consensus on TO parameters in Gastric Oncological Surgery (TOGS) hinders comparative outcomes analysis. This study aimed to establish a universally accepted set of TOGS parameters using Delphi consensus made by international experts in gastric cancer surgery. METHOD: The Delphi process involved four phases: 1. Evidence Acquisition: A systematic review revealed significant variability in TOGS parameters. 2. Expert Panel Discussion: Eight international experts developed 18 preliminary questions for a survey. 3. Delphi Process: Two rounds of anonymous surveys among key opinion leaders measured agreement using a 5-point Likert scale, with consensus defined as ≥ 70%. A third round was conducted to revise questions on mortality, lymph nodes, and hospital stay. 4. Generation of Recommendations were created based on consensus from the three rounds RESULTS: Of 53 invited surgeons, 39 responded, and 34 completed both rounds. By the second round, ten parameters were agreed upon. 1) No 90-day mortality; 2) No complications ≥ III according to Clavien-Dindo classification; 3) No intraoperative complications according to the GASTRODATA classification; 4) R0 resection; 5) More than 25 lymph nodes analyzed in the surgical specimen; 6) No reoperation; 7) No readmission to the Intensive care Unit (ICU); 8) No readmission in the first 30 postoperative days; 9) Length of stay below the 75th percentile of the series; 10) Resumption of chemotherapy treatment, if indicated, within 8 weeks after surgery. CONCLUSION: TOGS consensus definition includes ten parameters specific to gastric cancer treatment. Validation in clinical practice is needed to confirm the proposed TOGS definition as a universal quality metric.