Construction and validation of a prediction model for postoperative pulmonary complications undergoing thoracoscopic and laparoscopic esophagectomy
- VernacularTitle:胸腹腔镜联合食管癌根治术后发生肺部相关并发症风险预测模型的构建及验证
- Author:
Jie LIANG
1
;
Yingbin CAI
1
Author Information
- Publication Type:Journal Article
- Keywords: thoracoscopy-laparoscopy; radical resection of esophageal cancer; pulmonary complications; risk factors; prediction model; model validation
- From: China Journal of Endoscopy 2024;30(12):1-8
- CountryChina
- Language:Chinese
- Abstract: Objective To discuss risk factors of postoperative pulmonary complications (PPCs) with esophageal cancer treated by thoracoscopy and laparoscopy,and construct a risk prediction model to identify high-risk patients.Methods A retrospective analysis was performed on 189 patients underwent thoracoscopic and laparoscopic radical resection of esophageal cancer.Multivariate analysis performed on factors that may affect PPCs,and constructed risk prediction model.A prospective study was conducted,and 68 patients who underwent thoracoscopic and laparoscopic radical resection of esophageal cancer from January 2023 to December 2023 were selected and grouped according to the predictive model,and prospective studies were used to verify the clinical application value of prediction model for prediction of PPCs.Results In the 189 patients,53 patients (28.04％) developed PPCs.The results of univariate analysis showed that the age,smoking history,COPD,tumor location,FEV1/FVC,operation time,and ventilation strategy during operation were statistically significant between the group with pulmonary complications and the group without pulmonary complications (P<0.05).The results of multivariate Logistic analysis showed that the tumor location in the mediastinal upper segment,age ≥ 65 years,operation time longer than 210 minutes,poor lung function before surgery (FEV1/FVC<70％),COPD,and the use of traditional ventilation strategy during operation were independent risk factors for PPCs in patients (P<0.05).According to the results of univariate and multivariate analysis,a prediction model was constructed as Y=-3.646+1.565 × tumor location+1.451 × age+1.230 × operation time+1.216 × FEV1/FVC+1.170 × COPD+0.953 × ventilation strategy during operation.The receiver operator characteristic curve (ROC curve) was used to verify the predictive value of the model for PPCs.The area under the ROC curve of the above prediction model for PPCs was 0.869;the PPCs incidence rate in the high-risk group was significantly higher than that in the low-risk group within 7 days after surgery,with a statistically significant difference (P<0.05).Conclusion A tumor in the upper chest,age of 65 or older,surgery time of more than 210 minutes,poor lung function (FEV1/FVC<70％) before surgery,COPD,and traditional ventilation strategy are independent risk factors for the occurrence of PPCs in patients underwent thoracoscopic and laparoscopic radical resection of esophageal cancer.The risk prediction model based on these factors can accurately predict high-risk patients who are likely to develop PPCs,and has good clinical application value,which is worth further in-depth research.
