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An evidence-based model for predicting conversion to open surgery in minimally invasive distal pancreatectomy
Cong Chen1, Xianchao Lin1, Ronggui Lin1
1Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, China.
Background:
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.
Methods:
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.
Results:
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.
Conclusion:
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.
Insights
Minimally invasive distal pancreatectomy (MIDP) conversion to open surgery can be predicted using a new model. This tool helps surgeons select appropriate surgical approaches and counsel patients on conversion risks.
Area of Science:
- Surgical Oncology
- Medical Informatics
Background:
- Intraoperative conversion to open surgery is a complication of minimally invasive distal pancreatectomy (MIDP).
- Conversion is linked to worse patient outcomes.
- Predicting conversion is crucial for surgical planning.
Purpose of the Study:
- To develop and validate a predictive model for intraoperative conversion during MIDP.
- To identify independent risk factors associated with conversion.
Main Methods:
- Retrospective analysis of 352 MIDP patients.
- Random assignment to training and validation cohorts.
- Multivariate logistic regression to identify predictors.
- Model evaluation using ROC curves and decision curve analysis.
Main Results:
- Ten preoperative risk factors were identified.
- Sex, tumor proximity to major vessels, suspicion of malignancy, type of resection, and surgeon experience were significant predictors.
- The developed model demonstrated superior predictive accuracy compared to existing models.
Conclusions:
- An evidence-based prediction model for MIDP conversion was successfully developed.
- This model can aid in surgical approach selection and patient risk counseling.
- The model shows clinical utility and good consistency.
