| Objective:To explore the surgical risk factors of laparoscopic left sided hepatectomy for hepatolithiasis and establish and validate a nomogram to predict the corresponding surgical risks.Methods:Patients with hepatolithiasis who underwent laparoscopic left sided hepatectomy were retrospectively enrolled in Nanchang University Second Affiliated Hospital.Demographic data,clinicopathological parameters and surgical factors were collected.353 patients were enrolled and randomly divided into training set(n=267)and validation set(n=86)by 3:1.Conversion to laparotomy was used as a surrogate index to evaluate the surgical risk.Univariate analysis was used to screen potential surgical risk factors,and multivariate analysis using logistic regression model was used to screen independent surgical risk factors.Nomogram predicting the surgical risks was established based on the above factors.Discrimination,calibration,decision curve and clinical impact analyses were used to evaluate the performance of the nomogram both in the training and validation sets.Results:Five independent surgical risk factors were identified in the training set,including recurrent abdominal pain(OR=2.951,95%CI 1.173-7.426),choledocholith(OR=3.964,95%CI 1.417-11.086),bile duct stricture(OR= 3.246,95%CI1.319-7.989),ASA classification(OR=3.961,95%CI 1.177-13.332),extent of liver resection(OR=3.498,95%CI 1.406-8.702).No collinearity was found among these five factors,and a nomogram was established.Performance analyses of the nomogram showed good discrimination(AUC=0.804 and 0.794)and calibration(Hosmer-Lemeshow test,p=0.430 and 0.833)both in the training and validation sets.Decision curve and clinical impact analyses also showed that the predictionperformance was clinically valuable.Conclusions:A nomogram was established and validated to be effective in evaluating and predicting the surgical risk of patients undergoing laparoscopic left sided hepatectomy for hepatolithiasis. |
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