Impact of Obesity on Textbook Outcome Achievement in Minimally Invasive Colorectal Cancer Surgery

This retrospective observational study aims to evaluate the association between body mass index (BMI) and achievement of Textbook Outcome (TO) in patients undergoing minimally invasive colorectal cancer surgery. Patients who underwent curative minimally invasive colorectal cancer resection at a single tertiary referral center between 2021 and 2025 will be retrospectively evaluated. Patients will be categorized according to BMI as non-obese (BMI <30 kg/m²) and obese (BMI ≥30 kg/m²). Textbook Outcome will be assessed as a composite measure including R0 resection, retrieval of at least 12 lymph nodes, absence of major postoperative complications (Clavien-Dindo grade ≥IIIa), hospital stay ≤14 days, absence of 30-day readmission, and absence of 30-day mortality. The study will investigate whether BMI is associated with failure to achieve Textbook Outcome and will evaluate independent predictors of TO failure using multivariable logistic regression analysis.

Inclusion criteria

• Patients who underwent curative minimally invasive colorectal cancer resection at a single tertiary referral center between 2021 and 2025 were retrospectively reviewed. All patients were ≥18 years of age.

Exclusion criteria

• Patients undergoing metastatic resections, abdominoperineal resection (APR), Hartmann's procedure, multisegmental or total colectomy, transanal minimally invasive surgery (TAMIS), or palliative procedures were excluded from the analysis.