Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yan-ta Road, Xi'an, 710061, Shaanxi, P. R. China.
National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.
Surg Endosc. 2020 Dec;34(12):5360-5367. doi: 10.1007/s00464-019-07327-3. Epub 2020 Feb 3.
Laparoscopic splenectomy (LS) has been proven to be a safe and advantageous procedure. To ensure that resections of appropriate difficulty are selected, an objective preoperative grading of difficulty is required. We aimed to develop a predictive difficulty grading of LS based on intraoperative complications.
A total of 272 non-traumatic patients who underwent LS were identified from a regional medical center. Patients were randomized into a training cohort (n = 222) and a validation cohort (n = 50). Data on demographics, medical and surgical history, operative and pathological characteristics, and postoperative outcome details were collected. Univariate and multivariate analyses of risk factors for intraoperative complications were performed to develop a difficulty scoring system. The Spearman correlation coefficient was used to evaluate the relationship between the difficulty grading score and intraoperative outcomes. Receiver operating characteristic (ROC) curve was used to evaluate the discriminatory power of this scoring system.
Three preoperative factors (spleen weight, esophagogastric varices, and INR) had a significant effect on operative time, bleeding, and conversion to open surgery. We created a difficulty grading score with three levels of difficulty: low (≤ 4 points), medium (5-6 points), and high (≥ 7 points), based on the three preoperative parameters. The correlation was highly significant (P < 0.01) according to Spearman's correlation. The area under the ROC curve was 0.695 (95% CI 0.630-0.755). The external validation showed significant correlations with the present model, with an AUC of 0.725 (95% CI 0.580-0.842). The comparison between our difficulty score and the previous grading system in the 272-patient cohort presented a significant difference in the AUC (0.701, 95% CI 0.643-0.755 vs. 0.644, 95% CI 0.584-0.701, P = 0.0452).
The present difficulty scoring system, based on preoperative factors, has good performance in predicting the risk of intraoperative complications of LS and could be helpful for enabling appropriate case selection with respect to the current experience of a surgeon.
腹腔镜脾切除术（LS）已被证明是一种安全且有利的手术。为了确保选择适当难度的切除术，需要进行客观的术前难度分级。我们旨在基于术中并发症开发一种 LS 预测性难度分级。
从一个区域医疗中心确定了 272 例非创伤性接受 LS 的患者。将患者随机分为训练队列（n=222）和验证队列（n=50）。收集人口统计学、医疗和手术史、手术和病理特征以及术后结果详细信息。对术中并发症的危险因素进行单因素和多因素分析，以制定难度评分系统。使用 Spearman 相关系数评估难度分级评分与术中结果的关系。使用接收者操作特征（ROC）曲线评估该评分系统的鉴别能力。
术前三个因素（脾脏重量、胃食管静脉曲张和 INR）对手术时间、出血和转为开放性手术有显著影响。我们根据三个术前参数创建了一个具有三个难度级别的难度分级评分：低（≤4 分）、中（5-6 分）和高（≥7 分）。根据 Spearman 相关，相关性具有高度显著性（P<0.01）。ROC 曲线下面积为 0.695（95%CI 0.630-0.755）。外部验证显示与当前模型存在显著相关性，AUC 为 0.725（95%CI 0.580-0.842）。在 272 例患者队列中，我们的难度评分与之前的分级系统的比较在 AUC 上存在显著差异（0.701，95%CI 0.643-0.755 vs. 0.644，95%CI 0.584-0.701，P=0.0452）。
基于术前因素的本难度评分系统在预测 LS 术中并发症风险方面具有良好的性能，并且可以帮助根据外科医生的当前经验进行适当的病例选择。
