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However, inconsistent and variable reporting limits their clinical application.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This scoping review aimed to catalogue definitions and\u00a0criteria of TO and TOO in gastrectomy, report achievement rates and determinants, associations with survival outcomes, and identify methodological gaps.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A search was conducted in MEDLINE, Embase, Web of Science, and Scopus from inception to April 2025. Eligible studies reported TO or TOO for adults undergoing curative-intent gastrectomy for cancer. Reviewers screened studies and extracted data on characteristics, definitions, achievement rates, and survival outcomes. Owing to heterogeneity, findings were summarised narratively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Forty-five studies (published 2017\u20132025;\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009139,972 patients) were included. Definitions varied, with 26 unique components identified. Common components were adequate lymphadenectomy (\u2265\u200915 nodes), absence of postoperative complications (Clavien\u2013Dindo grade\u2009\u2265\u2009II), and no 30-day readmission. Median TO and TOO achievement rates were 58.6% (IQR: 37.6\u201375.8) and 30.3% (IQR: 23.6\u201340.2). The primary barriers were inadequate lymphadenectomy and CD\u2009\u2265\u2009II complications. Twelve studies reported a significant association between TO\/TOO and improved overall and disease-free survival. Influencing factors included age, comorbidity, tumour characteristics, surgeon volume, and surgical approach. Limitations included non-standardised definitions, limited patient-reported outcomes, and a lack of prospective validation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>TO and TOO are associated with improved survival in gastrectomy but are hampered by inconsistent definitions and limited prospective evidence. Standardisation, patient-reported outcomes, and prospective validation are needed to realise their potential as clinically useful quality metrics.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10120-025-01659-x","type":"journal-article","created":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T07:57:55Z","timestamp":1758873475000},"page":"1033-1045","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Textbook outcome in gastrectomy: useful metric or moving target? 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