Textbook Outcome After Oral Cancer Surgery as a Composite Measure for Survival and Quality-of-Care Evaluation

Hanneke Doremiek van Oorschot; Dominique Valerie Clarence de Jel; Jose Angelito Hardillo; Robert J J van Es; Guido B van den Broek; Robert Paul Takes; Gyorgy Bela Halmos; Richard Dirven; Martin Lacko; Lauretta Anna Alexandra Vaassen; Jan-Jaap Hendrickx; Marjolijn Abigal Eva-Maria Oomens; Hossein Ghaeminia; Jeroen C Jansen; Annemarie Vesseur; Rolf Bun; Leonora Q Schwandt; Christiaan A Krabbe; Thomas J W Klein Nulent; Alexander J M van Bemmel; Reinoud J Klijn; Robert Jan Baatenburg de Jong

doi:10.1002/ohn.1337

Textbook Outcome After Oral Cancer Surgery as a Composite Measure for Survival and Quality-of-Care Evaluation

Otolaryngol Head Neck Surg. 2025 Jun 24. doi: 10.1002/ohn.1337. Online ahead of print.

Authors

Hanneke Doremiek van Oorschot^{1

2}, Dominique Valerie Clarence de Jel³, Jose Angelito Hardillo¹, Robert J J van Es⁴, Guido B van den Broek⁵, Robert Paul Takes⁵, Gyorgy Bela Halmos³, Richard Dirven⁶, Martin Lacko⁷, Lauretta Anna Alexandra Vaassen⁸, Jan-Jaap Hendrickx⁹, Marjolijn Abigal Eva-Maria Oomens¹⁰, Hossein Ghaeminia¹⁰, Jeroen C Jansen¹¹, Annemarie Vesseur¹², Rolf Bun¹³, Leonora Q Schwandt¹⁴, Christiaan A Krabbe¹⁴, Thomas J W Klein Nulent¹⁵, Alexander J M van Bemmel¹⁶, Reinoud J Klijn¹⁷, Robert Jan Baatenburg de Jong¹

Affiliations

¹ Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Centre Cancer Institute, Rotterdam, The Netherlands.
² Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands.
³ Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
⁴ Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Centre, Utrecht, The Netherlands.
⁵ Department of Otorhinolaryngology, Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
⁶ Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
⁷ Department of Otorhinolaryngology and Head and Neck Surgery, GROW School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, The Netherlands.
⁸ Department of Cranio-Maxillofacial Surgery, GROW School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, The Netherlands.
⁹ Department of Otorhinolaryngology, Head and Neck Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
¹⁰ Department of Oral and Maxillofacial Surgery, Rijnstate Hospital, Arnhem, The Netherlands.
¹¹ Department of Otorhinolaryngology, Head and Neck Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
¹² Department of Otolaryngology, Head and Neck Surgery, Elisabeth Tweesteden Ziekenhuis Tilburg, Tilburg, The Netherlands.
¹³ Department of Oral and Maxillofacial Surgery/Head and Neck Oncology Noordwest Hospital Group, Alkmaar en Dijklander Hospital, Hoorn, The Netherlands.
¹⁴ Department of Oral and Maxillofacial Surgery, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
¹⁵ Department of Oral and Maxillofacial Surgery, Haaglanden Medical Center, The Hague, The Netherlands.
¹⁶ Department of Otorhinolaryngology and Head and Neck Surgery, Medisch Spectrum Twente, Enschede, The Netherlands.
¹⁷ Department of Oral and Maxillofacial and Head and Neck Surgery, Medisch Spectrum Twente, Enschede, The Netherlands.

PMID: 40552672
DOI: 10.1002/ohn.1337

Abstract

Objective: To enhance survival outcomes for oral cavity cancer (OCC) surgery, a composite measure has been developed: "textbook outcome" (TO). Three studies have reported on this concept in OCC, but the need for population-level results remains. This study investigates OCC surgery, focusing on survival and hospital-level results.

Study design: Cohort study.

Setting: National multicenter study.

Methods: All first primary OCC patients who underwent curative tumor resection between 2018 and 2021 were selected from the Dutch Head and Neck Audit database. Resections were categorized as local or extensive, the latter including neck dissection and/or free or pedicled flap reconstruction. TO was defined as the absence of 30-day mortality, hospital readmission, prolonged length-of-stay, severe complications, surgical margins <1 mm, and <18 lymph nodes per side. Adjusted hazard ratios (aHRs) were determined for 2-year overall survival (OS) and disease-free survival (DFS).

Results: TO was reached in 81.1% and 46.9% after local (1039 patients) and extensive (1227 patients) resection, respectively. Reduced TO rates were observed in females, non-squamous cell carcinoma, cT3-T4, and floor of mouth compared to tongue. Obtaining TO was significantly associated with less adjuvant therapy and improved 2-year survival after local (aHR 0.55 OS P = .004, 0.70 DFS P = .085) and extensive (aHR 0.61 OS P ≤ .001, 0.69 DFS P = .002) surgery. After correction for population differences, no interhospital variation in TO remained.

Conclusion: Achieving TO is strongly linked to improved survival, highlighting its importance as a short-term composite quality-of-care indicator. The separate outcomes that were influential to the hospital's TO score differed between hospitals, indicating opportunities to improve outcomes.

Keywords: clinical auditing; head and neck cancer; oral cavity cancer; quality of care evaluation; survival.