{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T05:38:35Z","timestamp":1790314715896,"version":"4.1.0"},"reference-count":34,"publisher":"Springer Science and Business Media LLC","issue":"8","license":[{"start":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T00:00:00Z","timestamp":1775174400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T00:00:00Z","timestamp":1775174400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100002551","name":"Seoul National University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002551","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Ann Surg Oncol"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Textbook Outcome defines the ideal perioperative course after surgery. A specific Textbook Outcome in Gastric Surgery (TOGS) was developed in Western centers; however, its validation among Eastern patients has rarely been investigated. We assessed its achievement in a Korean cohort and identified its predictors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We included adults who underwent curative distal or total gastrectomy for gastric cancer (GC) between 2013 and 2023. TOGS consisted of three surgical criteria (no intraoperative complications, R0 resection, and adequate lymphadenectomy: &gt;\u00a020 nodes in subtotal and &gt;\u00a025 in total gastrectomy) and four postoperative criteria (no re-intervention, no unplanned intensive care unit stay, no unplanned 90-day readmission or mortality).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the 5806 patients with GC enrolled, 4338 (74.7%) achieved the TOGS, with rates of 77.9% for stage I tumors and 68.8% for stages II\u2013III. The TOGS rate declined with age, from 82.3% in patients aged &lt;\u00a040 years to 67.5% in those aged &gt;80 years, with hospital readmission being the strongest negative predictor of its achievement in the elderly. Several factors were independently associated with a higher likelihood of TOGS: early lesions (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.003), female sex (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt;\u00a00.001), recent surgery (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.024), distal gastrectomy (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt;\u00a00.001), and minimally invasive approach (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt;\u00a00.001). Patients with TOGS had shorter hospital stays (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.014) and improved 5-year overall survival (87.6%, vs. 75.6%,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt;\u00a00.001), independent of the pathological stage (stage I,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt;\u00a00.001; stages II\u2013III,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt;\u00a00.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The new definition of TOGS provides valuable insights into the quality of surgical care for patients with GC and has a strong impact on oncological outcomes, including in Eastern patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1245\/s10434-026-19522-3","type":"journal-article","created":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T19:03:59Z","timestamp":1775243039000},"page":"7283-7292","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Validation of Textbook Outcome in Gastric Surgery (TOGS) for Primary Gastric Cancer in an Eastern High-Volume Center"],"prefix":"10.1245","volume":"33","author":[{"given":"Ludovico","family":"Carbone","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yo-Seok","family":"Cho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min Kyu","family":"Kang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyoyoung","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane Chungyoon","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sa-Hong","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeesun","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nina Rebecca","family":"Kalaw","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoonjin","family":"Kwak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hye Seung","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seong-Ho","family":"Kong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Do Joong","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele","family":"Marrelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Han-Kwang","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franco","family":"Roviello","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyuk-Joon","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,3]]},"reference":[{"issue":"5","key":"19522_CR1","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1038\/s41571-023-00747-0","volume":"20","author":"AP Thrift","year":"2023","unstructured":"Thrift AP, Wenker TN, El-Serag HB. 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