Hong QQ, Yan S, Zhao YL, Fan L, Yang L, Zhang WB, Liu H, Lin HX, Zhang J, Ye ZJ, Shen X, Cai LS, Zhang GW, Zhu JM, Ji G, Chen JP, Wang W, Li ZR, Zhu JT, Li GX, You J. Machine learning identifies the risk of complications after laparoscopic radical gastrectomy for gastric cancer. World J Gastroenterol 2024; 30(1): 79-90 [PMID: 38293327 DOI: 10.3748/wjg.v30.i1.79]
Corresponding Author of This Article
Jun You, PhD, Doctor, Department of Gastrointestinal Oncology Surgery, The First Affiliated Hospital of Xiamen University, School of Medicine, No. 55 Zhenhai Road, Xiamen 361001, Fujian Province, China. youjun@xmu.edu.cn
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Clinical Trials Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an 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/
World J Gastroenterol. Jan 7, 2024; 30(1): 79-90 Published online Jan 7, 2024. doi: 10.3748/wjg.v30.i1.79
Table 1 Demographic and clinical characteristics of the training group and validation groups (mean ± SD)
Characteristic
Training group
Validation group
LGC (n = 998)
LTG (n = 572)
LDG (n = 426)
LGC (n = 398)
LTG (n = 165)
LDG (n = 233)
Age
59.8 (11.31)
60.0 (11.22)
59.6 (11.44)
57.8 (12.4)
59.2 (12.2)
57.0 (12.4)
Gender
Female
307
156
151
173
45
82
male
691
416
275
342
120
151
BMI
22.6 (3.2)
22.9 (3.2)
22.3 (3.2)
22.6 (3.4)
22.7 (3.6)
22.5 (3.4)
ASA score
2
964
556
408
365
148
217
3
34
16
18
33
17
16
ECOG score
0
810
460
350
142
69
73
1
158
98
60
231
89
142
2
30
14
16
25
7
18
Severe heart disease
4
1
3
22
17
5
Severe lung disease
10
5
5
18
12
6
Hypertension
140
71
69
78
39
39
Diabetes
67
30
37
52
27
25
Operative time (min)
240 (63.0)
246.8 (73.1)
230.9 (44.6)
280.9 (76.4)
308.0 (86.1)
267.2 (68.9)
Bleeding volume (min)
130.5 (115.4)
147.8 (128.5)
107.3 (90.0)
54.3 (57.6)
78.7 (67.4)
57.9 (51.6)
Blood transfusion (mL)
25.5 (138.1)
34.3 (172.3)
13.62 (67.9)
19.0 (132.4)
11.0 (65.1)
22.0 (154.0)
Complication
139
64
75
78
51
27
ClavienDindo
0
859
508
351
320
114
206
1
14
5
9
17
10
7
2
93
34
59
56
38
18
3
29
24
5
5
3
2
4
3
1
2
0
0
0
Table 2 Incidence of complications in the training group and validation groups
Training group
Validation group
Complication
164
78
Anastomotic leakage
23
11
Anastomotic stricture
5
5
Anastomotic bleeding
6
0
Pancreatic fistula
3
0
Gastric and Intestinal stasis
10
0
Bleeding of peritoneal cavity
7
1
Surgical incision infection or fat liquefaction
18
3
Pulmonary infection
42
5
Abdominal infection
27
29
Sepsis
5
0
Urinary tract infection
1
13
Intestinal obstruction
14
7
Lymphorrhea
10
4
Deep vein thrombosis
1
1
Pulmonary embolism
1
1
Cardiac arrhythmia
0
0
Biliary leakage
1
0
Table 3 Univariate analysis of severe complications after laparoscopic distal gastrectomy in gastric cancer patients
Variate
No-severe complication (%)
Severe complication (%)
t/χ2
P value
OR
95%CI
Age group
Age ≤ 65
239
38
1.905
0.168
Age > 65
121
28
1.455
0.852-2.485
Gender
Male
234
41
0.095
0.758
Female
126
25
1.132
0.658-1.948
BMI group
BMI ≤ 28
347
57
9.49
0.002
BMI > 28
13
9
4.215
1.722-10.313
Hb
129.7 ± 26.6
126.8 ± 26.2
0.797
0.424
0.996
0.986-1.006
ALB
40.7 ± 4.85
40.3 ± 4.03
0.707
0.48
0.98
0.927-1.036
Tumor size
3.2 ± 1.8
3.5 ± 2.0
-1.346
0.179
1.101
0.967-1.266
Bleeding volume
103.3 ± 89.2
128.6 ± 91.9
-2.109
0.036
1.003
1.000-1.005
Operative time
230.7 ± 45.1
232.4 ± 42.2
-0.282
0.778
1.001
0.995-1.007
Blood transfusion
6.9 ± 49.86
50.00 ± 121.8
-27.381
< 0.001
1.006
1.003-1.010
Severe heart disease
No
359
64
2.748
0.064
Yes
1
2
11.219
1.002-125.553
Severe lung disease
No
358
63
4.601
0.032
Yes
2
3
8.524
1.396-52.039
Hypertension
No
302
55
0.013
0.91
Yes
58
11
1.041
0.541-2.109
Diabetes
No
329
60
0.016
0.899
Yes
31
6
1.061
0.424-2.654
Surgerical type
Totally
82
20
1.734
0.188
Assisted
278
46
0.678
0.380-1.212
Reconstruction
Billroth I
90
12
6.133
0.105
Billroth II
106
26
1.840
0.878-3.854
Roux-en-Y
113
24
1.593
0.755-3.360
Billroth II + Braun
51
4
0.588
0.180-19.19
ECOG score
0
323
27
95.605
< 0.001
1
34
26
9.148
4.804-17.421
2
3
13
51.840
13.913-193.157
ASA score
2
353
55
29.802
< 0.001
10.086
3.750-27.124
Table 4 Univariate analysis of severe complications after laparoscopic total gastrectomy in gastric cancer patients
Variate
No-severe complication (%)
Severe complication (%)
t/χ2
P value
OR
95%CI
Age group
Age < 65
332
30
4.381
0.036
Age ≥ 65
181
29
1.733
1.032-3.047
Gender
Male
372
44
0.113
0.736
Female
141
15
0.899
0.485-1.667
BMI group
BMI ≤ 28
481
53
1.319
0.251
BMI > 28
32
6
1.702
0.680-4.257
Hb
129.1 ± 25.1
135.2 ± 25.7
-1.754
0.08
1.01
0.999-1.021
ALB
40.4 ± 3.1
39.7 ± 3.2
1.664
0.097
0.928
0.851-1.013
Tumor size
4.0 ± 2.2
3.8 ± 1.9
0.674
0.501
0.95
0.826-1.092
Bleeding volume
150.2 ± 133.5
130.2 ± 70.0
1.114
0.255
0.998
0.995-1.001
Operative time
248.9 ± 73.9
229.0 ± 62.5
1.983
0.048
0.996
0.991-1.000
Intraoperative blood transfusion
37.1 ± 180.8
10.17 ± 54.8
{0.099}
0.754
0.998
0.995-1.002
Severe heart disease
No
512
59
0.115
0.734
Yes
1
0
Severe lung disease
No
511
56
13.461
< 0.001
Yes
2
3
13.687
2.239-83.665
Hypertension
No
452
49
1.245
0.264
Yes
61
10
1.512
0.728-3.140
Diabetes
No
489
53
3.21
0.073
Yes
24
6
2.307
0.902-5.896
Surgerical type
totally
230
35
4.467
0.035
assisted
283
24
0.557
0.322-0.964
ECOG
0
426
34
22.379
< 0.001
1
77
21
3.417
1.883-6.199
2
10
4
5.012
1.493-16.824
ASA
2
505
51
28.024
< 0.001
3
8
8
9.902
3.566-27.499
Citation: Hong QQ, Yan S, Zhao YL, Fan L, Yang L, Zhang WB, Liu H, Lin HX, Zhang J, Ye ZJ, Shen X, Cai LS, Zhang GW, Zhu JM, Ji G, Chen JP, Wang W, Li ZR, Zhu JT, Li GX, You J. Machine learning identifies the risk of complications after laparoscopic radical gastrectomy for gastric cancer. World J Gastroenterol 2024; 30(1): 79-90