Digestive Surgical Oncology Department, National Institute of Oncology, Ibn Sina University Hospital, Rabat, Morocco.
Equipe de Recherche en Oncologie Translationnelle (EROT), Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco.
BMC Surg. 2022 May 10;22(1):162. doi: 10.1186/s12893-022-01617-9.
This study aimed to externally evaluate the accuracy of four predictive scores for conversion to open surgery after rectal laparoscopic resection. None of the four scores achieved external validation previously.
This was a retrospective analysis of two prospectively maintained databases from two academic centers in France and Morocco. All consecutive patients who underwent laparoscopic resection for rectal adenocarcinoma between 2005 and 2020 were included. Logistic regression was used to assess the association between the factors present in the four scores and conversion. The accuracy of each score was assessed using the area under the curve (AUC). Observed and predicted conversion rates were compared for each score using the Chi-square goodness-of-fit test.
Four hundred patients were included. There were 264 men (66%) with a mean age of 65.95 years (standard deviation 12.2). The median tumor height was 7 cm (quartiles 4-11) and 29% of patients had low rectal tumors. Conversion rate was 21.75%. The accuracy to predict conversion was low with an AUC lower than 0,62 for the four models. The observed conversion rates were significantly different from the predicted rates, except for one score.
The four models had low accuracy in predicting the conversion to open surgery for laparoscopic rectal resection. There is a need for new well-designed studies, analyzing more specific variables, in a multicentric design to ensure generalizability of the results for daily surgical practice.
本研究旨在对外评估四个预测直肠腹腔镜切除术后转为开放性手术的评分的准确性。这四个评分都没有之前进行过外部验证。
这是对来自法国和摩洛哥的两个学术中心的两个前瞻性维护数据库的回顾性分析。所有连续接受腹腔镜直肠腺癌切除术的患者均被纳入研究。使用逻辑回归评估了四个评分中存在的因素与转化之间的关联。使用曲线下面积（AUC）评估每个评分的准确性。使用卡方拟合优度检验比较每个评分的观察到的和预测的转化率。
共纳入 400 例患者。264 例（66%）为男性，平均年龄为 65.95 岁（标准差 12.2）。肿瘤高度中位数为 7cm（四分位数为 4-11），29%的患者为低位直肠肿瘤。转换率为 21.75%。四个模型预测转换的准确性都较低，AUC 均低于 0.62。除了一个评分外，观察到的转换率与预测率显著不同。
四个模型预测腹腔镜直肠切除术后转为开放性手术的准确性较低。需要在多中心设计中进行新的设计良好的研究，分析更具体的变量，以确保结果在日常手术实践中的普遍性。
