---
title: "Textbook Outcome After Esophagectomy for Esophageal Cancer: Evidence, Definitions, and Future Dire"
id: "pubmed-42665417"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42665417"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42665417/"
doi: "10.21873/invivo.14414"
published_at: "2026-09-01T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Textbook Outcome After Esophagectomy for Esophageal Cancer: Evidence, Definitions, and Future Dire
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42665417
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42665417/)
- **DOI:** [10.21873/invivo.14414](https://doi.org/10.21873%2Finvivo.14414)
- **Published At:** 2026-09-01T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Esophagectomy remains the primary curative treatment for resectable **esophageal cancer**, but it carries higher perioperative morbidity and mortality and longer hospital stays than other gastrointestinal cancers. - The quality of the perioperative surgical course affects both short- and long-term oncologic outcomes across malignancies, prompting interest in composite quality metrics. - The concepts of **textbook outcome (TO)** and **textbook oncological outcome (TOO)** were developed to evaluate perioperative quality using multiple elements rather than single endpoints. - In 2017 a TO for esophageal cancer (EC) was proposed that included 10 short-term surgical outcome measures: curative resection, no intraoperative complications, R0 resection, adequate number of harvested lymph nodes, no severe postoperative complication, no reintervention, no ICU readmission, no readmission, no prolonged hospital stay, and no mortality. - In 2021 the TO for EC was redefined with nine revised short-term surgical parameters (details of the specific revisions were reported in the literature). - Observational studies have shown that achieving a TO after esophagectomy is associated with improved survival. - Before widespread clinical adoption of TO for EC, clinicians and systems must understand the characteristics and limitations of individual studies that support TO, including definitions, included elements, and outcome associations. - The review summarizes background, current status, and future perspectives of TO for resectable EC and highlights the need for careful implementation and further study to optimize esophagectomy outcomes.
## Clinical Analysis & Structured Key Points
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Affiliations Expand ### Affiliations * 1 Department of Gastrointestinal Surgery, Yokohama City University, Yokohama, Japan; t-aoyama@lilac.plala.or.jp. * 2 Department of Gastric Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan. * 3 Department of Gastrointestinal Surgery, Yokohama City University, Yokohama, Japan. # Contributed equally. * PMID: **42665417** * DOI: [ 10.21873/invivo.14414 ](https://doi.org/10.21873/invivo.14414) Item in Clipboard Review # Textbook Outcome After Esophagectomy for Esophageal Cancer: Current Evidence and Future Perspectives Toru Aoyama et al. In Vivo. 2026 Sep-Oct. Show details Display options Display options Format Abstract PubMed PMID In Vivo Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22In+Vivo%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22In+Vivo%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42665417/) . 2026 Sep-Oct;40(5):2589-2595. doi: 10.21873/invivo.14414. ### Authors [Toru Aoyama](https://pubmed.ncbi.nlm.nih.gov/?term=Aoyama+T&cauthor_id=42665417)[#](https://pubmed.ncbi.nlm.nih.gov/42665417/#short-view-equal-contrib-explanation "Contributed equally")[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42665417/#short-view-affiliation-1 "Department of Gastrointestinal Surgery, Yokohama City University, Yokohama, Japan; t-aoyama@lilac.plala.or.jp.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42665417/#short-view-affiliation-2 "Department of Gastric Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan."), [Taiici Kawabe](https://pubmed.ncbi.nlm.nih.gov/?term=Kawabe+T&cauthor_id=42665417)[#](https://pubmed.ncbi.nlm.nih.gov/42665417/#short-view-equal-contrib-explanation "Contributed equally")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42665417/#short-view-affiliation-3 "Department of Gastrointestinal Surgery, Yokohama City University, Yokohama, Japan."), [Haruhiko Cho](https://pubmed.ncbi.nlm.nih.gov/?term=Cho+H&cauthor_id=42665417)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42665417/#short-view-affiliation-2 "Department of Gastric Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan."), [Takaki Yoshikawa](https://pubmed.ncbi.nlm.nih.gov/?term=Yoshikawa+T&cauthor_id=42665417)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42665417/#short-view-affiliation-3 "Department of Gastrointestinal Surgery, Yokohama City University, Yokohama, Japan.") ### Affiliations * 1 Department of Gastrointestinal Surgery, Yokohama City University, Yokohama, Japan; t-aoyama@lilac.plala.or.jp. * 2 Department of Gastric Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan. * 3 Department of Gastrointestinal Surgery, Yokohama City University, Yokohama, Japan. # Contributed equally. * PMID: **42665417** * DOI: [ 10.21873/invivo.14414 ](https://doi.org/10.21873/invivo.14414) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID ## Abstract Esophagectomy is an essential treatment for resectable esophageal cancer. However, perioperative morbidity and mortality are higher and postoperative hospital stay is longer than other gastrointestinal malignancies. However, quality of perioperative surgical course affects both short- and long-term oncological outcomes in various malignancies. Recently, textbook outcome (TO)/textbook oncological outcome (TOO) are developed to evaluate quality of perioperative surgical course. TO/TOO included various perioperative elements and introduced in various malignancies. In esophageal cancer surgery, in 2017, TO for esophageal cancer (EC) defined and included 10 short-term surgical outcomes (curative resection, no intraoperative complications, R0 resection, number of harvest lymph node, no sever postoperative complication, no reintervention, no readmission intensive care unit, no readmission, no prolonged hospital stay, and no mortality). In 2021, TO for EC redefinition was made and included nine revised short-term surgical parameters. Previous studies demonstrated that achieved TO associated with better survival after esophagectomy for EC. To optimize esophagectomy for EC, it is necessary to understand the characteristics of each study before the widespread implementation of TO in clinical practice. This review summarizes the background, current status, and future perspectives of TO for resectable EC. **Keywords:** Esophageal cancer; esophagectomy; overall survival; perioperative outcomes; review; textbook outcome. Copyright © 2026, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Similar articles * [ Textbook Outcome/Textbook Oncological Outcome for Pancreatic Cancer Treatment. ](https://pubmed.ncbi.nlm.nih.gov/42379736/) Aoyama T, Cho H, Saito A.Aoyama T, et al.In Vivo. 2026 Jul-Aug;40(4):1865-1871. doi: 10.21873/invivo.14341.In Vivo. 2026.PMID: 42379736Free PMC article.Review. * [ Robot-assisted minimally invasive thoraco-laparoscopic esophagectomy versus open transthoracic esophagectomy for resectable esophageal cancer, a randomized controlled trial (ROBOT trial). ](https://pubmed.ncbi.nlm.nih.gov/23199187/) van der Sluis PC, Ruurda JP, van der Horst S, Verhage RJ, Besselink MG, Prins MJ, Haverkamp L, Schippers C, Rinkes IH, Joore HC, Ten Kate FJ, Koffijberg H, Kroese CC, van Leeuwen MS, Lolkema MP, Reerink O, Schipper ME, Steenhagen E, Vleggaar FP, Voest EE, Siersema PD, van Hillegersberg R.van der Sluis PC, et al.Trials. 2012 Nov 30;13:230. doi: 10.1186/1745-6215-13-230.Trials. 2012.PMID: 23199187Free PMC article.Clinical Trial. * [ Textbook outcomes after oesophagectomy: a single-centre observational study. ](https://pubmed.ncbi.nlm.nih.gov/38066440/) Buchholz V, Hazard R, Lee DK, Liu DS, Zhang W, Chen S, Aly A, Barnett S, Le P, Weinberg L.Buchholz V, et al.BMC Surg. 2023 Dec 8;23(1):368. doi: 10.1186/s12893-023-02253-7.BMC Surg. 2023.PMID: 38066440Free PMC article. * [ The Association of Textbook Outcome and Long-Term Survival After Esophagectomy for Esophageal Cancer. ](https://pubmed.ncbi.nlm.nih.gov/33221197/) Kalff MC, Vesseur I, Eshuis WJ, Heineman DJ, Daams F, van der Peet DL, van Berge Henegouwen MI, Gisbertz SS.Kalff MC, et al.Ann Thorac Surg. 2021 Oct;112(4):1134-1141. doi: 10.1016/j.athoracsur.2020.09.035. Epub 2020 Nov 19.Ann Thorac Surg. 2021.PMID: 33221197 * [ Textbook outcome for esophageal cancer surgery: an international consensus-based update of a quality measure. ](https://pubmed.ncbi.nlm.nih.gov/33744921/) Kalff MC, van Berge Henegouwen MI, Gisbertz SS.Kalff MC, et al.Dis Esophagus. 2021 Jul 12;34(7):doab011. doi: 10.1093/dote/doab011.Dis Esophagus. 2021.PMID: 33744921Free PMC article. 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