Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, China.
Surg Endosc. 2024 Nov;38(11):6423-6436. doi: 10.1007/s00464-024-11216-9. Epub 2024 Sep 3.
Intraoperative conversion to open surgery is an adverse event during minimally invasive distal pancreatectomy (MIDP), associated with poor postoperative outcomes. The aim of this study was to develop a model capable of predicting conversion in patients undergoing MIDP.
A total of 352 patients who underwent MIPD were included in this retrospective analysis and randomly assigned to training and validation cohorts. Potential risk factors related to open conversion were identified through a literature review, and data on these factors in our cohort was collected accordingly. In the training cohort, multivariate logistic regression analysis was performed to adjust the impact of confounding factors to identify independent risk factors for model building. The constructed model was evaluated using the receiver operating characteristics curve, decision curve analysis (DCA), and calibration curves.
Following an extensive literature review, a total of ten preoperative risk factors were identified, including sex, BMI, albumin, smoker, size of lesion, tumor close to major vessels, type of pancreatic resection, surgical approach, MIDP experience, and suspicion of malignancy. Multivariate analysis revealed that sex, tumor close to major vessels, suspicion of malignancy, type of pancreatic resection (subtotal pancreatectomy or left pancreatectomy), and MIDP experience persisted as significant predictors for conversion to open surgery during MIDP. The constructed model offered superior discrimination ability compared to the existing model (area under the curve, training cohort: 0.921 vs. 0.757, P < 0.001; validation cohort: 0.834 vs. 0.716, P = 0.018). The DCA and the calibration curves revealed the clinical usefulness of the nomogram and a good consistency between the predicted and observed values.
The evidence-based prediction model developed in this study outperformed the previous model in predicting conversions of MIDP. This model could contribute to decision-making processes surrounding the selection of surgical approaches and facilitate patient counseling on the conversion risk of MIDP.
微创远端胰腺切除术（MIDP）过程中转开腹是一种不良事件，与术后不良结果相关。本研究旨在建立一种能够预测 MIDP 中转开腹的模型。
本回顾性分析纳入了 352 例行 MIPD 的患者，并将其随机分配至训练集和验证集。通过文献回顾确定了与开放转换相关的潜在风险因素，并收集了本队列中这些因素的数据。在训练集中，进行多变量逻辑回归分析以调整混杂因素的影响，确定模型构建的独立危险因素。使用受试者工作特征曲线、决策曲线分析（DCA）和校准曲线评估所构建模型。
经过广泛的文献回顾，共确定了 10 个术前危险因素，包括性别、BMI、白蛋白、吸烟者、病灶大小、肿瘤靠近大血管、胰腺切除术类型、手术入路、MIDP 经验和恶性肿瘤可疑度。多变量分析显示，性别、肿瘤靠近大血管、恶性肿瘤可疑度、胰腺切除术类型（胰体尾切除术或左胰切除术）和 MIDP 经验是 MIDP 中转开腹的显著预测因素。所构建的模型在区分能力方面优于现有模型（训练集：曲线下面积，0.921 对 0.757，P<0.001；验证集：0.834 对 0.716，P=0.018）。DCA 和校准曲线显示了列线图的临床实用性和预测值与实际值之间的良好一致性。
本研究中建立的基于证据的预测模型在预测 MIDP 中转开腹方面优于之前的模型。该模型有助于选择手术方式的决策过程，并为患者提供关于 MIDP 中转开腹风险的咨询。
