Objective To analyze the influencing factors of not achieving textbook outcome(TO)after laparoscopic radical surgery in patients with malignant pancreatic body and tail tumor,and to establish and evaluate a nomogram for predicting the failure to achieve TO.Methods The clinical data of 111 patients with malignant pancreatic body and tail tumors undergoing laparoscopic radical surgery in the Department of Hepatobiliary and Pancreatic Surgery in Henan Provincial People's Hospital from January 2020 to December 2022 were retrospectively analyzed,including 44 males and 67 females,aged(53.8±14.7)years.All patients were staged TNM Ⅰ to Ⅱ,including pancreatic ductal adenocarcinoma(n=102,91.9％),pancreatic neuroendocrine tumor(n=5,4.5％),and pancreatic intraductal papillary mucinous tumors(n=4,3.6％).The patients were randomly divided into a training set(n=78)and a test set(n=33)at a ratio of 7∶3.The 78 patients in the training set were further divided into TO group(n=28)and control group(n=50,not achieving TO).Based on the univariate and multivariate logistic regression analy-sis of training set,the influencing factors of failure to achieve TO after laparoscopic radical surgery in patients with pancreatic body and tail tumor were analyzed.A nomogram based on the multi-factors were established to predict the failure to achieve TO.Receiver operating characteristic(ROC)curve,calibration curve,decision curve analysis(DCA)were utilized to evaluate the nomogram.Results There were signifi-cant differences in tumor diameter,positive lymph nodes,operation time and CT value of pancreas between the TO and control groups(all P＜0.05).Multivariate logistic regression analysis showed that tumor diame-ter＞4 cm(OR=9.673,95％CI:2.198-42.579),positive lymph node(OR=5.385,95％CI:1.514-19.154),pancreatic CT value(OR=0.594,95％CI:0.392-0.902)were the influencing factors for patients who did not achieve TO(all P＜0.05).Based on the results of multiple factors,a nomogram was established to predict the failure to achieve TO after laparoscopic radical surgery.The area under the ROC curve of the nomogram was 0.849(95％CI:0.757-0.940)and 0.873(95％CI:0.730-1.000)in the training and test sets,respectively.The calibration curve was close to the ideal curve and the predicted results of the nomogram matched well with the actual results.The DCA showed that the nomogram has obvi-ous positive net benefit.Conclusion The nomogram constructed with tumor diameter＞4 cm,positive lymph nodes and CT value of pancreas for prediction of the patients with pancreatic body and tail malignant tumor after laparoscopic radical surgery did not achieve TO has good performance.
Pancreatic neoplasmsSurgical procedures,operativeTextbook outcomePre-diction model
NETL
NSTL
万方数据
