悪性小腸閉塞に対する手術の適応候補者を特定するためのノモグラムの開発と検証

Malignant small bowel obstruction (MSBO) is a severe complication frequently associated with advanced intra-abdominal malignancies, substantially compromising patient survival and quality of life. Surgical management of MSBO remains controversial due to its high postoperative morbidity and mortality. This study aimed to develop and validate a nomogram to identify patients with MSBO who are most likely to benefit from surgical intervention.

This retrospective study included patients diagnosed with MSBO who underwent surgery at the Affiliated Hospital of Qingdao University between January 2019 and December 2022. Univariate and multivariate analyses were performed, and least absolute shrinkage and selection operator (LASSO) regression was applied in R to identify independent predictors and construct the nomogram. Model performance was evaluated using receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA).

A total of 132 patients were included, among whom 69 were in the surgical benefit group (SB group) and 63 in the surgical non-benefit group (SNB group). Serum albumin (mean: 35.67 ± 3.581 vs. 32.45 ± 4.708, P = 0.004), maximum small bowel dilation diameter (mean: 0.71 ± 0.076 vs. 0.76 ± 0.085, P = 0.047), the ratio of anteroposterior to transverse abdominal diameter (mean: 0.72 ± 0.058 vs. 0.77 ± 0.059, P = 0.017), liver metastases (0.20vs 0.56, P < 0.01), ascites (0.61vs0.30, P < 0.01) were selected as the predictive variables of the nomogram. Through internal validation, we found that the model has good accuracy. Furthermore, the calibration curve indicated the model's ability to accurately assess individuals who would benefit from surgical intervention, and the Decision Curve Analysis(DCA)curve confirming its potential good clinical utility.

The proposed nomogram, integrating serum albumin, maximum small bowel dilation diameter, the ratio of anteroposterior to transverse abdominal diameter, liver metastases, and ascites, demonstrated robust discriminatory performance and clinical applicability in predicting which patients with malignant small bowel obstruction (MSBO) are likely to benefit from surgery. This tool may assist clinicians in making individualized, evidence-based treatment decisions. Prospective multicenter validation is needed to confirm its utility and facilitate its incorporation into routine clinical practice.