Li Ping, Huang Chang-Ming, Lin Jian-Xian, Zheng Chao-Hui, Xie Jian-Wei, Wang Jia-Bin, Lu Jun, Chen Qi-Yue, Cao Long-Long, Lin Mi, Tu Ru-Hong, Chen Rui Fu
Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
Surg Endosc. 2016 Sep;30(9):4092-101. doi: 10.1007/s00464-015-4725-5. Epub 2015 Dec 23.
The purpose of this study was to evaluate the risk factors that influence the difficulty of performing laparoscopic spleen-preserving splenic hilar lymph node dissection (SHLND) for gastric cancer and to establish a simple and effective scoring system to predict the surgical difficulty preoperatively.
Between January 2011 and December 2013, we prospectively collected and retrospectively analyzed the medical records of 317 patients with upper- or middle-third gastric cancer who underwent laparoscopic spleen-preserving SHLND. Univariate and multivariate analyses were performed to determine the independent predictors for surgical difficulty based on the operation time during spleen-preserving SHLND. A logistic regression model was used to identify determinant variables and construct a predictive difficulty scoring system.
Multivariate analysis showed that gender, body mass index (BMI), number of splenic lobar arteries (SLAs), and type of SLA were independently predictive factors of operation time. According to these factors, we developed a predictive surgical difficulty scoring system and the difficulty levels are divided into 0, 1, 2, 3, and 4 points or more. Based on the relative risk, we stratified the surgical difficulty into the following three divisions: 0 low difficulty, 1-2 intermediate difficulty, and 3 points or more high difficulty. The patients with long operation time accounted for 19.6, 43.6, and 90.9 % for the three groups, respectively (p < 0.001). The area under the receiver operating characteristic curve for the logistic regression model and the simplified difficulty scoring prediction model was 0.717 and 0.715, respectively.
Based on four independent risk factors, including gender, BMI, number of SLAs, and type of SLA, we developed a simple and effective scoring system to predict the difficulty of laparoscopic spleen-preserving SHLND preoperatively. This novel scoring system might aid surgeons with different experience in performing operations at different levels of difficulty.
本研究旨在评估影响腹腔镜保脾脾门淋巴结清扫术（SHLND）治疗胃癌难度的危险因素，并建立一种简单有效的评分系统以术前预测手术难度。
2011年1月至2013年12月期间，我们前瞻性收集并回顾性分析了317例接受腹腔镜保脾SHLND的上三分之一或中三分之一胃癌患者的病历。基于保脾SHLND术中的手术时间，进行单因素和多因素分析以确定手术难度的独立预测因素。使用逻辑回归模型识别决定变量并构建预测难度评分系统。
多因素分析显示，性别、体重指数（BMI）、脾叶动脉数量（SLA）和SLA类型是手术时间的独立预测因素。根据这些因素，我们开发了一种预测手术难度评分系统，难度水平分为0、1、2、3和4分及以上。基于相对风险，我们将手术难度分为以下三个等级：0级低难度，1 - 2级中等难度，3分及以上高难度。三组患者手术时间长的比例分别为19.6%、43.6%和90.9%（p < 0.001）。逻辑回归模型和简化难度评分预测模型的受试者工作特征曲线下面积分别为0.717和0.715。
基于性别、BMI、SLA数量和SLA类型这四个独立危险因素，我们开发了一种简单有效的评分系统以术前预测腹腔镜保脾SHLND的难度。这种新颖的评分系统可能有助于不同经验的外科医生进行不同难度水平的手术。
