Development and validation of a preoperative nomogram for predicting the surgical difficulty of laparoscopic colectomy for right colon cancer: a retrospective analysis

Abstract

Background: In laparoscopic right hemicolectomy for right colon cancer, complete mesocolic excision is a standard procedure that involves extended lymphadenectomy and blood vessel ligation. This study aimed to establish a nomogram to facilitate evaluation of the surgical difficulty of laparoscopic right hemicolectomy based on preoperative parameters. Materials and methods: The preoperative clinical and computed tomography-related parameters, operative details, and postoperative outcomes were analyzed. The difficulty of laparoscopic colectomy was defined using the scoring grade reported by Escal et al. with modifications. Multivariable logistic analysis was performed to identify parameters that increased the surgical difficulty. A preoperative nomogram to predict the surgical difficulty was established and validated. Results: A total of 418 consecutive patients with right colon cancer who underwent laparoscopic radical resection at a single tertiary medical center between January 2016 and May 2022 were retrospectively enrolled. The patients were randomly assigned to a training data set (n=300, 71.8%) and an internal validation data set (n=118, 28.2%). Meanwhile, an external validation data set with 150 consecutive eligible patients from another tertiary medical center was collected. In the training data set, 222 patients (74.0%) comprised the non-difficulty group and 78 (26.0%) comprised the difficulty group. Multivariable analysis demonstrated that adipose thickness at the ileocolic vessel drainage area, adipose area at the ileocolic vessel drainage area, adipose density at the ileocolic vessel drainage area, presence of the right colonic artery, presence of type III Henle’s trunk, intra-abdominal adipose area, plasma triglyceride concentration, and tumor diameter at least 5 cm were independent risk factors for surgical difficulty; these factors were included in the nomogram. The nomogram incorporating seven independent predictors showed a high C-index of 0.922 and considerable reliability, accuracy, and net clinical benefit. Conclusions: The study established and validated a reliable nomogram for predicting the surgical difficulty of laparoscopic colectomy for right colon cancer. The nomogram may assist surgeons in preoperatively evaluating risk and selecting appropriate patients.

Nomogram for predicting difficult total laparoscopic hysterectomy: a multi-institutional, retrospective model development and validation study

“…Interestingly, defining what constitutes a “difficult surgery” itself is challenging. Currently, most studies identify a surgery as difficult based on adverse events occurring during or after the procedure and utilize certain outcome measures as surrogate markers for defining “difficult surgery.” In studies on the difficulty of laparoscopic total hysterectomy and laparoscopic colon resection, researchers have unanimously chosen surgical time, blood loss, Dindo–Clavien II–III grade complications, conversion to open surgery, and length of hospital stay as surrogate markers 24 , 25 . Our study also drew from the definition of “surgical difficulty” in other surgical fields and defined surgical difficulty based on four perioperative indicators: surgical time exceeding the 75th percentile (surgical time ≥130 min), total blood loss greater than 500 ml, conversion to open surgery, and occurrence of adjacent organ injury.…”

A commentary on ‘Development and validation of a preoperative nomogram for predicting the surgical difficulty of laparoscopic colectomy for right colon cancer: a retrospective analysis’

“…Yu et al . 2 . conducted a retrospective study to define preoperative predictors that affect surgical difficulty and to establish a preoperative nomogram for predicting the surgical difficulty of minimally invasive right hemicolectomy.…”