Establishment Of A Nomogram Model For Predicting Risk Factors For Complications After Total Gastrectomy

ObjectiveMany preoperative and intraoperative risk factors will affect the complications after total gastrectomy.To explore the potential risk factors for complications after total gastrectomy and to establish a nomogram prediction model for internal validation.The purpose of this prediction model is to help gastrointestinal surgery in more medical centers to evaluate the risk of postoperative complications more accurately,and take necessary preventive measures for high-risk patients to improve the incidence of postoperative complications,and finally achieve the purpose of improving the effect of surgical treatment and improving the survival and prognosis of patients.MethodsThe clinical data of 112 patients with gastric cancer who underwent total gastrectomy in the Department of Gastrointestinal Surgery of the The First Affiliated Hospital of Shandong First Medical University from January 2016 to December 2020 were collected.All postoperative complications were graded according to the Clavien-Dindo grading system,and the risk factors for postoperative complications ≥ grade Ⅱ were statistically analyzed by χ2 test.Multivariate logistic regression analysis was used to screen the potential risk factors for≥ grade Ⅱ postoperative complications,and a nomogram prediction model was established.This sample was used as the training group,and 61 patients who also underwent total gastrectomy in this specialty from January 2021 to June 2022 were used as the validation group for internal validation.Decision curve analysis(DCA)is introduced to evaluate the clinical benefit of the prediction model.ResultsPostoperative complications occurred in 41 patients(36.6%)with gastric cancer.Multivariate logistic regression analysis showed that N=3(OR=6.1,P=0.012),the largest diameter of the tumor(OR=1.15,P=0.037)and Charlson comorbidity index(CCI)(OR=1.49,P=0.013)were independent risk factors for grade II postoperative complications.The established nomogram model showed good discrimination and prediction consistency in both the training and validation groups.ConclusionThe risk of postoperative complications was higher when the maximum diameter of tumor was more than 6.45 cm,in stage N=3 and the preoperative Charlson complication score was more than 2.The nomogram prediction model based on the three independent risk factors has good predictive performance for complications after total gastrectomy and has certain clinical significance and reference value.