Discussion
right colon cancer, tumor
REGRESSION, TUMOR, COLON CANCER, POSTOPERATIVE COMPLICATIONS
D3 surgery is widely recognized as the standard procedure in laparoscopic radical right hemicolectomy for right colon cancer. Despite multiple extensive discussions about the surgical access for this procedure involving completely medial access by the page-turning approachConsidering few studies have assessed the surgical difficulty of the right hemicolectomy, we established a surgical difficulty score system based on the study of Escal In the present study, retrospective analyses of 300 patients’ data using a multifactorial approach revealed that the factors influencing the occurrence of surgical difficulty were the adipose thickness, area, and density at the drainage area of the ileocolic vessels, presence of the right colonic artery, presence of type III Henle’s trunk, abdominal adipose area, plasma triglyceride concentration, and tumor diameter at least 5 cm. The BMI was not an influencing factor, which is in contrast to a previous study that reported that BMI influences the difficulty of surgery for colon cancerStaging the Henle’s trunk of all patients in the training data set showed that 119 patients had type I (39.7%), 84 had type II (28.0%), 43 had type III (14.3%), 14 had type IV (4.7%), and 40 had type V (13.3%)Right colonic angiogenesis reportedly occurs in ~12–45% of patientsBased on the multivariable analysis results, the optimal model (logistic regression model) was selected by the machine learning algorithm, and the prediction model of surgical difficulty was established. The calibration curve was highly consistent with the fitting line, reflecting the high accuracy of the prediction model. The C-indexes of the prediction model were 0.922 for the training data set, 0.992 for the internal validation data set, and 0.994 for the external validation data set, indicating the high credibility of the prediction capability of the model.The present study has certain limitations. First, this is a retrospective study with small sample sizes, and larger sample sizes from more centers are warranted for further validation. Second, few studies have evaluated predictive models of the difficulty of colon surgery based on CT values, and many young surgeons lack experience in assessing CT values, which may limit the wide application of our study. Despite these limitations, to our knowledge, the present study is the first to construct a nomogram based on CT values to assess the difficulty of right hemicolectomy, which may contribute to the stratification of patients before D3 radical surgery for colon cancer. Internal validation, external validation, and bootstrap validation in the cohort indicated the good predictive power of the model, which is conducive to making surgical decisions and reducing the incidence of postoperative complications after D3 surgery.