Construction of a nomogram model to predict technical difficulty in performing laparoscopic sphincter-preserving radical resection for rectal cancer  

作　　者：Xiao-Cong Zhou Shi-Wei Guan Fei-Yue Ke Gaurav Dhamija Qiang Wang Bang-Fei Chen 

机构地区：[1]Medical University(Wenzhou Central Hospital),Wenzhou 325000,Zhejiang Province,China [2]Department of Hepatobiliary Surgery,The Dingli Clinical Institute of Wenzhou Medical University(Wenzhou Central Hospital),Wenzhou 325000,Zhejiang Province,China [3]Postgraduate Training Base Alliance of Wenzhou Medical University,Wenzhou Central Hospital,Wenzhou 325000,Zhejiang Province,China [4]School of International Studies,Wenzhou Medical University,Wenzhou Central Hospital,Wenzhou 325000,Zhejiang Province,China [5]Department of Radiology,The Dingli Clinical Institute of Wenzhou Medical University(Wenzhou Central Hospital),Wenzhou 325000,Zhejiang Province,China [6]Department of Colorectal Surgery,The Affiliated Zhejiang Hospital,Zhejiang University School of Medicine(Zhejiang Hospital),Hangzhou 310000,Zhejiang Province,China

出　　处：《World Journal of Gastroenterology》2024年第18期2418-2439,共22页世界胃肠病学杂志（英文版）

基　　金：Institutional review board statement:The study was reviewed and approved by the Wenzhou Central Hospital Institutional Review Board(Approval No.K2018-01-003).

摘　　要：BACKGROUND Colorectal surgeons are well aware that performing surgery for rectal cancer becomes more challenging in obese patients with narrow and deep pelvic cavities.Therefore,it is essential for colorectal surgeons to have a comprehensive understanding of pelvic structure prior to surgery and anticipate potential surgical difficulties.AIM To evaluate predictive parameters for technical challenges encountered during laparoscopic radical sphincter-preserving surgery for rectal cancer.METHODS We retrospectively gathered data from 162 consecutive patients who underwent laparoscopic radical sphincterpreserving surgery for rectal cancer.Three-dimensional reconstruction of pelvic bone and soft tissue parameters was conducted using computed tomography(CT)scans.Operative difficulty was categorized as either high or low,and multivariate logistic regression analysis was employed to identify predictors of operative difficulty,ultimately creating a nomogram.RESULTS Out of 162 patients,21(13.0%)were classified in the high surgical difficulty group,while 141(87.0%)were in the low surgical difficulty group.Multivariate logistic regression analysis showed that the surgical approach using laparoscopic intersphincteric dissection,intraoperative preventive ostomy,and the sacrococcygeal distance were independent risk factors for highly difficult laparoscopic radical sphincter-sparing surgery for rectal cancer(P<0.05).Conversely,the anterior-posterior diameter of pelvic inlet/sacrococcygeal distance was identified as a protective factor(P<0.05).A nomogram was subsequently constructed,demonstrating good predictive accuracy(C-index=0.834).CONCLUSION The surgical approach,intraoperative preventive ostomy,the sacrococcygeal distance,and the anterior-posterior diameter of pelvic inlet/sacrococcygeal distance could help to predict the difficulty of laparoscopic radical sphincter-preserving surgery.

关 键 词：NOMOGRAM Rectal cancer Laparoscopic operation Sphincter-preserving surgery Technical difficulty 

分 类 号：R735.37[医药卫生—肿瘤]