Textbook Oncological Outcome After Liver Resection

About the calculator

This calculator estimates the predicted probability of achieving a Textbook Oncological Outcome¹ following liver resection for malignant disease, using a machine learning model developed from a retrospective cohort of patients undergoing liver resection between 1999 and 2023.

Once validated this tool is intended to support preoperative counselling, shared decision-making, and multidisciplinary team discussion. It should not be used as a standalone decision-making tool.

What is a Textbook Oncological Outcome?

A Textbook Oncological Outcome, or TOO, is a composite measure of ideal surgical and oncological recovery. It follows an “all-or-nothing” principle, meaning that a patient only achieves TOO if all predefined criteria are met. The international consensus definition of TOO in liver surgery has been defined by the absence of 7 criteria¹:

1. Grade ≥2 intraoperative incidents
2. 90-day postoperative complications of Clavien–Dindo III or higher
3. 90-day readmission due to surgery-related complications of Clavien–Dindo Grade 3 or higher
4. Postoperative bile leakage of grades B and C
5. Postoperative liver failure of grades B and C
6. In-hospital or 90-day mortality
7. R1 or R2 resection margins

Reference

1. Gorgec B, Benedetti Cacciaguerra A, Pawlik TM, et al. An International Expert Delphi Consensus on Defining Textbook Outcome in Liver Surgery (TOLS). Ann Surg. 2023;277(5):821-828. doi: 10.1097/SLA.0000000000005668.

Risk Categories

Group	Predicted Probability of achieving TOO	TOO rate observed in cohort
Low risk	$\ge$0.858	90.6%
Moderate risk	0.604 – 0.858	80.0%
High risk	$\le$0.604	37.7%

Disclaimer

This application is an experimental tool for research purposes only based on retrospective data and has not been clinically validated for patient care. This application is intended for educational and informational purposes only. The information provided by this application is not a substitute for professional medical advice, diagnosis, or treatment.

The content generated by this application should not be used as the sole basis for making medical decisions.

We do not assume any liability for the use of this application. The accuracy, completeness, and timeliness of the information provided cannot be guaranteed.

By using this application, you acknowledge and agree that you are doing so at your own risk.

Research Team Contact

For further information please contact Dr Meet Patel – meet.patel@sydney.edu.au