Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 14, 2019; 25(38): 5838-5849
Published online Oct 14, 2019. doi: 10.3748/wjg.v25.i38.5838
Nomogram to predict prolonged postoperative ileus after gastrectomy in gastric cancer
Wen-Quan Liang, Ke-Cheng Zhang, Jian-Xin Cui, Hong-Qing Xi, Ai-Zhen Cai, Ji-Yang Li, Yu-Hua Liu, Jie Liu, Wang Zhang, Peng-Peng Wang, Bo Wei, Lin Chen
Wen-Quan Liang, Ke-Cheng Zhang, Jian-Xin Cui, Hong-Qing Xi, Ai-Zhen Cai, Ji-Yang Li, Wang Zhang, Peng-Peng Wang, Bo Wei, Lin Chen, Department of General Surgery & Institute of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
Yu-Hua Liu, Institute of Army Hospital Management, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
Jie Liu, Department of Vascular and Endovascular Surgery, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
Author contributions: Chen L, Wei B, Liang WQ, Zhang KC, and Cui JX designed the study; Liang WQ, Zhang KC, and Cui JX wrote the manuscript; Xi HQ and Cai AZ contributed to the patient material; Li JY and Liu YH collected the clinical data; Liu J, Zhang W, and Wang PP contributed to data analysis and validation; Liang WQ, Zhang KC, and Cui JX contributed equally to this work.
Supported by the National Nature Science Foundation of China, No. 81672319, No. 81602507, and No. 81773135; the National Key Research and Development Plan, No. 2017YFC0908300; and Beijing Nova Program, No. Z181100006218011.
Institutional review board statement: The study was approved by the Research Ethics Committee of the Chinese People’s Liberation Army General Hospital.
Informed consent statement: All study participants provided written consent prior to study enrollment.
Conflict-of-interest statement: All the authors have no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected byan in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Lin Chen, MA, MD, PhD, Chief Doctor, Professor, Department of General Surgery & Institute of General Surgery, Chinese People’s Liberation Army General Hospital, 28 Fuxing Road, Beijing 100853, China. chenlin@301hospital.com.cn
Telephone: +86-10-66937164 Fax: +86-10-68181689
Received: July 15, 2019
Peer-review started: July 16, 2019
First decision: August 2, 2019
Revised: September 5, 2019
Accepted: September 11, 2019
Article in press: September 11, 2019
Published online: October 14, 2019
Abstract
BACKGROUND

Prolonged postoperative ileus (PPOI) is one of the common complications in gastric cancer patients who underwent gastrectomy. Evidence on the predictors of PPOI after gastrectomy is limited and few prediction models of nomogram are used to estimate the risk of PPOI. We hypothesized that a predictive nomogram can be used for clinical risk estimation of PPOI in gastric cancer patients.

AIM

To investigate the risk factors for PPOI and establish a nomogram for clinical risk estimation.

METHODS

Between June 2016 and March 2017, the data of 162 patients with gastrectomy were obtained from a prospective and observational registry database. Clinical data of patients who fulfilled the criteria were obtained. Univariate and multivariable logistic regression models were performed to detect the relationship between variables and PPOI. A nomogram for PPOI was developed and verified by bootstrap resampling. The calibration curve was employed to detect the concentricity between the model probability curve and ideal curve. The clinical usefulness of our model was evaluated using the net benefit curve.

RESULTS

This study analyzed 14 potential variables of PPOI in 162 gastric cancer patients who underwent gastrectomy. The incidence of PPOI was 19.75% in patients with gastrectomy. Age older than 60 years, open surgery, advanced stage (III–IV), and postoperative use of opioid analgesic were independent risk factors for PPOI. We developed a simple and easy-to-use prediction nomogram of PPOI after gastrectomy. This nomogram had an excellent diagnostic performance [area under the curve (AUC) = 0.836, sensitivity = 84.4%, and specificity = 75.4%]. This nomogram was further validated by bootstrapping for 500 repetitions. The AUC of the bootstrap model was 0.832 (95%CI: 0.741–0.924). This model showed a good fitting and calibration and positive net benefits in decision curve analysis.

CONCLUSION

We have developed a prediction nomogram of PPOI for gastric cancer. This novel nomogram might serve as an essential early warning sign of PPOI in gastric cancer patients.

Keywords: Prolonged postoperative ileus, Gastric cancer, Complication, Nomogram, Bootstrap

Core tip: Prolonged postoperative ileus (PPOI) is one of the common complications in gastric cancer patients who underwent gastrectomy. Evidence on the predictors of PPOI after gastrectomy is limited. This study investigated the risk factors for PPOI and established an easy-to-use nomogram model for clinical risk estimation. This nomogram had an excellent diagnostic performance and showed superior effects when used in the clinical setting based on the results of the decision curve analysis. This novel nomogram might serve as an essential early warning sign of PPOI for medical practitioners.