A Nomogram For Preoperative Estimation Of The Difficulty Of Laparoscopic Pancreaticoduodenectomy

Background: Pancreaticoduodenectomy is a standard procedure for the of periampullary diseases,including carcinomas,precancerous lesions and parts of benign diseases.With the development of minimally invasive surgery,laparoscopic pancreaticoduodenectomy(LPD)has been widely accepted.However,LPD is still technically demanding due to the complexity of operation and the limitation of laparoscopic surgery.The study is to establish a model to evaluate the difficulty of laparoscopic pancreaticoduodenectomy.Methods: The study included 102 patients who underwent LPD from January 2016 to July 2019 at the First Affiliated Hospital of Chongqing Medical University,which all the data was collected retrospectively.Of these,patients were divided into the training group(n=72)and the validation group(n=30).The independent predictors for the difficulty of LPD were investigated,and a LPD difficulty nomogram was constructed.Results: Univariate analysis showed that gender(P<0.001),diabetes(P=0.034),preoperative chronic pancreatitis(P=0.003),the distancebetween the lesion and the superior mesenteric vein(SMV)or portal vein(PV,P=0.001)and the lesion size(P=0.002)were the risk factors significantly associated with the difficulty of LPD.According to multivariate analysis,male gender(P=0.002),present preoperative chronic pancreatitis(P=0.046),short distance between the lesion and the SMV or PV(P<0.001)and large lesion size(P=0.016)were the independent predictors about the difficulty of LPD and all of them were included in the corresponding nomogram.The nomogram displayed an unadjusted C-index of 0.903 and a bootstrap-corrected C-index of 0.881.ROC analysis showed that the nomogram had a large AUC(0.903).Conclusions: The proposed nomogram consisting of gender,preoperative chronic pancreatitis,the distance from the lesion to the SMV or PV and the lesion size was associated with the risk about the difficulty of LPD.Using the model,the index for LPD difficulty to an individual patient can be determined,which can lead to an optional surgery choice for surgeon(laparoscopic or open).