Long-term Outcome Evaluation And Prediction Analysis Of Laparoscopic Left Sided Hepatectomy For Hepatolithiasis

Objective:To explore the risk factors of long-term effects of laparoscopic left hepatectomy for hepatolithiasis and construct a predictive model.Methods:Clinical data of 108 patients with hepatolithiasis who underwent laparoscopic left sided hepatectomy and with complete follow-up data were retrospectively collected from June 2011 to June 2016 at the Second Affiliated Hospital of Nanchang University.Twenty-six males and eighty-two females were enrolled.The average age were(52.4 ± 11.7)years(range: 20 ~ 80 years),and the median follow-up time were36 months(24 ~ 83 months).Patients were randomly divided into training group(79cases)and validation group(29 cases)with a ratio of about 3:1.Twenty-five preoperative and intraoperative clinical factors were selected for potential factors that may affect long-term outcomes,and quality of life was used as an surrogate evaluation index.Univariate analysis and multivariate logistic regression analysis were used to investigate the potential risk factors,and were used to construct and validate the predictive nomogram for surgical outcomes.Results:Among 108 patients,10 patients(9.3%)had residual stones,8 patients(7.4%)had recurrence of stones,12 patients(11.1%)had recurrent cholangitis,and 3 patients(2.8%)had died.Univariate analysis showed that History of hepatobiliary surgery,gender,APTT(activation of partial thromboplastin time),ALP(alkaline phosphatase),use of choledochoscopy,postoperative stone residual,serum create-nine,postoperat-ive biliary drainage,and operation time are risk factors that may affect long-term outcome(P value <0.15),multivariate analysis showed that the history of previous hepatobiliary surgery(OR=2.305,95% CI: 0.383~4.227,P=0.019),postoperative biliary drainage(OR=2.043,95% CI: 0.182~4.209,P=0.048),operation time ?262.5minutes(OR=1.971,95% CI: 0.154~4.023,P=0.045)was independent risk factor affecting long-term outcome.Based on the above factors,the nomogram predictionmodel was constructed,Internal and external validations showed good discrimination(ROC area under the curve>0.7)and calibration(Hosmer-Lemeshow test P>0.05)performance,which indicated that the prediction effect is favorable.Conclusion:The history of previous hepatobiliary surgery,postoperative biliary drainage,and operation time ?262.5 minutes are independent risk factors for long-term outcome.The predictive nomogram model based on risk factors related to surgical outcomes has good clinical predictive effect.The prediction of the long-term effects of laparoscopic left hepatectomy for hepatolithiasis provides clinical reference value.