Retrospective Cohort Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 14, 2024; 30(18): 2418-2439
Published online May 14, 2024. doi: 10.3748/wjg.v30.i18.2418
Construction of a nomogram model to predict technical difficulty in performing laparoscopic sphincter-preserving radical resection for rectal cancer
Xiao-Cong Zhou, Shi-Wei Guan, Fei-Yue Ke, Gaurav Dhamija, Qiang Wang, Bang-Fei Chen
Xiao-Cong Zhou, Department of Colorectal Surgery, The Dingli Clinical Institute of Wenzhou Medical University (Wenzhou Central Hospital), Wenzhou 325000, Zhejiang Province, China
Shi-Wei Guan, Department of Hepatobiliary Surgery, The Dingli Clinical Institute of Wenzhou Medical University (Wenzhou Central Hospital), Wenzhou 325000, Zhejiang Province, China
Fei-Yue Ke, Postgraduate Training Base Alliance of Wenzhou Medical University, Wenzhou Central Hospital, Wenzhou 325000, Zhejiang Province, China
Gaurav Dhamija, School of International Studies, Wenzhou Medical University, Wenzhou Central Hospital, Wenzhou 325000, Zhejiang Province, China
Qiang Wang, Department of Radiology, The Dingli Clinical Institute of Wenzhou Medical University (Wenzhou Central Hospital), Wenzhou 325000, Zhejiang Province, China
Bang-Fei Chen, Department of Colorectal Surgery, The Affiliated Zhejiang Hospital, Zhejiang University School of Medicine (Zhejiang Hospital), Hangzhou 310000, Zhejiang Province, China
Co-first authors: Xiao-Cong Zhou and Shi-Wei Guan.
Author contributions: Zhou XC and Guan SW are co-first authors, equally contributing to tasks such as literature review, data collection, statistical analysis, interpretation, and manuscript drafting. This designation reflects their shared effort and collaborative approach across surgical specialties. The research was a joint endeavor, with co-first authorship accurately reflecting workload, time, and effort distribution. This ensures effective post-submission management, enhancing paper quality. The diverse team’s expertise is represented by co-first authors, enriching understanding through varied perspectives. Additionally, Ke FY and Dhamija G aided in study design, data interpretation, and manuscript revisions; Wang Q handled radiological data analysis; Chen BF, as senior author, oversaw the study, offering guidance on methodology and manuscript refinement to uphold intellectual standards.
Supported by Zhejiang Province Public Welfare Technology Application Research Funding Project, China, No. LGC21H160002; Basic Scientific Research Projects in Wenzhou City, Zhejiang Province, China, No. Y20220885; and Wenzhou Medical University 2021 Higher Education Teaching Reform Project, Zhejiang Province, China, No. JG2021167.
Institutional review board statement: The study was reviewed and approved by the Wenzhou Central Hospital Institutional Review Board (Approval No. K2018-01-003).
Informed consent statement: Due to the retrospective cohort study design, the need for informed consent was waived by the Wenzhou Central Hospital Institutional Review Board.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bang-Fei Chen, MD, Chief Physician, Department of Colorectal Surgery, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine (Zhejiang Hospital), No. 1229 Gudun Road, Hangzhou 310000, Zhejiang Province, China. 2730375001@qq.com
Received: November 30, 2023
Revised: February 6, 2024
Accepted: April 17, 2024
Published online: May 14, 2024
Processing time: 206 Days and 2.3 Hours
Abstract
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 sphincter-preserving 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.

Keywords: Nomogram, Rectal cancer, Laparoscopic operation, Sphincter-preserving surgery, Technical difficulty

Core Tip: This retrospective cohort study developed a nomogram to predict technical difficulty prior to laparoscopic sphincter-preserving radical resection for rectal cancer. Significant predictive factors were identified through multivariate logistic regression, including the surgical approach using laparoscopic intersphincteric dissection, intraoperative preventive ostomy, the sacrococcygeal distance, and the anterior-posterior diameter of pelvic inlet/sacrococcygeal distance. The nomogram’s clinical value lies in enabling surgeons to preoperatively evaluate expected difficulty and customize surgical approaches accordingly. It aids in individualized surgical planning.