Nomogram for predicting anastomotic stricture after choledochal cyst excision in children: retrospective cohort study of 1700 patients
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View abstract on PubMed
Summary
This summary is machine-generated.This study developed a nomogram to predict postoperative anastomotic stricture (AS) risk in children after choledochal cyst excision. The tool aids surgical decisions and post-operative care to prevent complications.
Area Of Science
- Pediatric Surgery
- Surgical Oncology
- Gastroenterology
Background
- Choledochal cysts are congenital biliary anomalies requiring surgical intervention.
- Anastomotic stricture (AS) is a significant postoperative complication following choledochal cyst excision.
- Accurate risk prediction is crucial for optimizing patient management and outcomes.
Purpose Of The Study
- To develop and validate a predictive nomogram for postoperative anastomotic stricture (AS) risk in pediatric patients undergoing choledochal cyst excision.
- To identify key predictors influencing AS development after hepaticojejunostomy.
- To provide a clinical tool for risk stratification and personalized management.
Main Methods
- Retrospective analysis of 1700 pediatric patients who underwent choledochal cyst excision with Roux-en-Y hepaticojejunostomy.
- Development of a nomogram using LASSO and multivariable logistic regression on a training cohort (80%).
- Validation of the nomogram's performance using concordance index (C-index), AUC, calibration curves, and decision curve analysis (DCA) in a validation cohort (20%).
Main Results
- Four independent predictors for AS were identified: perioperative biliary infection, anastomotic location, anastomotic diameter, and Roux-en-Y limb length.
- The nomogram demonstrated excellent predictive accuracy in both training (C-index=0.826) and validation cohorts (C-index=0.884).
- The model showed good calibration and clinical utility as confirmed by calibration curves and DCA.
Conclusions
- The developed nomogram is a reliable tool for predicting AS risk in pediatric patients post-choledochal cyst surgery.
- This tool can aid intraoperative decision-making and guide postoperative surveillance strategies.
- Further validation in prospective, multicenter studies is recommended to confirm its broader applicability.
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