Xi Cheng, Zhu Maoqun, Ji Tianhao, Tan Yulin, Zhuang Lin, Yuan Zhiping, Zhang Zheng, Xu Litian, Liu Zhilin, Xu Xuezhong, Xue Wenbo, Ding Wei
Department of General Surgery, Wujin Hospital Affiliated with Jiangsu University, Changzhou, China.
Department of General Surgery, The Wujin Clinical college of Xuzhou Medical University, Changzhou, China.
Front Oncol. 2022 Sep 29;12:1019763. doi: 10.3389/fonc.2022.1019763. eCollection 2022.
To develop a novel difficulty scoring system (NDSS) to predict the surgical difficulty of laparoscopic hepatectomy.
A total of 138 patients with liver tumors performed liver resection (LLR) between March 2017 to June 2022 were selected from Affiliated Hospital of Jiangnan University and Wujin Hospital Affiliated with Jiangsu University.Patient demographics, laboratory tests, intraoperative variables, pathological characteristics were assessed. We also assessed the Child Pugh score and the DSS-B score.
Patients were divided into training and testing cohort according to their hospital. Patients in training cohort were divided into high and low difficult groups based on operation time, blood loss and conversion. Higher percentage of patients with malignant liver tumor (87.0% vs. 58.1%; = 0.003) or history of hepatobiliary surgery (24.1% vs. 7.0%; = 0.043) in high difficult group than in low difficult group. To improve the difficulty scoring system, we incorporated the history of hepatobiliary surgery and nature of the tumor. A novel difficulty scoring system was established. The results showed that the operation time ( < 0.001), blood loss ( < 0.001), ALT ( < 0.001) and AST ( = 0.001) were associated with the novel difficulty score significantly. Compared with DSS-B, the NDSS has a higher area under the receiver operating characteristic (AUROC) (0.838 vs. 0.814). The nomogram was established according to the NDSS. The AUROCs of the nomogram in training and testing cohort were 0.833 and 0.767. The calibration curves for the probability of adverse event showed optimal agreement between the probability as predicted by the nomogram and the actual probability.
We developed a nomogram with the NDSS that can predict the difficulty of LLR. This system could more accurately reflect the difficulty of surgery and help liver surgeons to make the surgical plan and ensure the safety of the operation.
开发一种新型难度评分系统（NDSS）以预测腹腔镜肝切除术的手术难度。
选取2017年3月至2022年6月间在江南大学附属医院和江苏大学附属武进医院接受肝切除术（LLR）的138例肝肿瘤患者。评估患者的人口统计学资料、实验室检查、术中变量、病理特征。我们还评估了Child Pugh评分和DSS - B评分。
根据患者所在医院将其分为训练队列和测试队列。训练队列中的患者根据手术时间、出血量和中转情况分为高难度组和低难度组。高难度组中恶性肝肿瘤患者（87.0%对58.1%；P = 0.003）或有肝胆手术史患者（24.1%对7.0%；P = 0.043）的比例高于低难度组。为改进难度评分系统，我们纳入了肝胆手术史和肿瘤性质。建立了一种新型难度评分系统。结果显示手术时间（P < 0.001）、出血量（P < 0.001）、谷丙转氨酶（ALT，P < 0.001）和谷草转氨酶（AST，P = 0.001）与新型难度评分显著相关。与DSS - B相比，NDSS的受试者操作特征曲线下面积（AUROC）更高（0.838对0.814）。根据NDSS建立了列线图。训练队列和测试队列中列线图的AUROC分别为0.833和0.767。不良事件概率的校准曲线显示列线图预测的概率与实际概率之间具有最佳一致性。
我们开发了一种基于NDSS的列线图，可预测LLR的难度。该系统能更准确地反映手术难度，帮助肝脏外科医生制定手术方案并确保手术安全。
