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Validation of a nomogram with inflammation-based markers developed to predict difficult laparoscopic cholecystectomy
Masashi Utsumi1, Masaru Inagaki2, Ryusei Takahashi2
1Department of Surgery, National Hospital Organization Fukuyama Medical Center, 4-14-17 Okinogami-cho, Fukuyama City, 720-8520, Hiroshima, Japan. utsumi.masashi.vn@mail.hosp.go.jp.
Purpose:
To identify the predictors of difficult laparoscopic cholecystectomy (LC) in patients with acute cholecystitis (AC) and to develop a corresponding nomogram.
Methods:
In this retrospective study, we divided patients who underwent LC for acute cholecystitis into a training cohort (223 patients) and a validation cohort (88 patients). We defined difficult LC (DLC) as that resulting in blood loss ≥ 50 mL, operative time ≥ 150 min, or conversion to open surgery (DLC group).
Results:
In the training cohort, the postoperative complication incidence and hospitalization duration were greater in the DLC group than in the non-DLC group (n = 130; 58.3% vs. n = 93; 41.7%, respectively). Multivariate analysis identified male sex, preoperative Glasgow Prognostic Score ≥ 1, neutrophil-to-lymphocyte ratio ≥ 6.75, symptom duration ≥ 72 h, and pericholecystic fat hyperdensity on computed tomography (CT) as independent predictors of DLC. The corresponding nomogram showed good discrimination (area under the curve of 0.806), with 77.55% sensitivity and 72.1% specificity, acceptable calibration, and clinical utility according to decision curve analysis.
Conclusion:
Our nomogram predicts DLC reliably and could be used for preoperative risk assessment and surgical treatment planning.
