A Novel Nomogram for Prediction of Early Postoperative Complications of Total Gastrectomy for Gastric Cancer

Figures & data

Figure 1 Flow of patients through this retrospective study. Ultimately, 363 patients were enrolled who underwent TG for GC.

Table 1 Comparison of Clinical and Pathological Data of the Patients

Variable	All Patients (n=363)			Patients After Matching (n=72)
	With Early Postoperative Complications (n=43)	Without Early Postoperative Complications (n=320)	P	With Early Postoperative Complications (n=36)	Without Early Postoperative Complications (n=36)	P
Age (years)	65.40	66.03	0.6944	66.64	69.08	0.1891
Gender			0.5187			0.9999
Male	30	238		27	27
Female	13	82		9	9
BMI	22.58	22.98	0.4867	22.82	22.41	0.5616
Tumor long diameter	4.733	5.140	0.3822	4.808	5.000	0.7573
Tumor short diameter	3.453	3.810	0.3022	3.550	3.644	0.8422

Abbreviation: BMI, body mass index.

Figure 2 Distribution Figure: After matching between the two groups, the score distribution is consistent, and the matching effect is good.

Figure 3 Histogram Figure: After matching between the two groups, the score distribution is consistent, and the matching effect is good.

Table 2 Surgical and Pathological Outcome of the Patients

Variable	All Patients (n=363)			Patients After Matching (n=72)
	With Early Postoperative Complications (n=43)	Without Early Postoperative Complications (n=320)	P	With Early Postoperative Complications (n=36)	Without Early Postoperative Complications (n=36)	P
Preoperative albumin	36.54	37.34	0.3316	36.39	39.38	0.0099
Preoperative hemoglobin	117.0	118.3	0.7469	113.8	121.9	0.1586
Hypertension			0.3141			0.6236
Yes	18	109		14	12
No	25	211		22	24
Diabetes			0.7837			0.4533
Yes	5	42		3	5
No	38	278		33	31
Cardiopulmonary			0.0829			0.4533
Yes	6	21		5	3
No	37	299		31	33
Renal impairment			0.2443			0.5215
Yes	2	6		2	1
No	41	314		34	35
ASA staging			0.0897			0.7807
I	20	170		22	20
II	17	133		10	10
III	6	17		4	6
IV	0	0		0	0
V	0	0		0	0
VI	0	0		0	0
ECOG			0.9784			0.7050
0	30	223		25	28
1	12	91		10	7
2	1	6		1	1
3	0	0		0	0
4	0	0		0	0
5	0	0		0	0
Stapler			0.0686			0.0090
LS	13	59		12	3
CS	30	261		24	33
Blood transfusion			0.9978			0.1336
Yes	16	119		15	9
No	27	201		21	27
Jejunal feeding tube			0.4286			0.7814
Yes	9	85		8	9
No	34	235		28	27
Operation time	224.9	229.3	0.7155	223.4	220.7	0.8506
Vascular invasion			0.3335			0.2296
Yes	13	121		12	17
No	30	199		24	19
Nerve invasion			0.6974			0.8119
Yes	18	144		16	15
No	25	176		20	21
T stage			0.0007			0.0422
1–2	14	41		11	4
3–4	29	279		25	32
Number of total lymph nodes	21.12	22.15	0.3961	20.14	21.25	0.4330
Number of positive lymph nodes	4.093	5.565	0.1832	4.250	5.944	0.2628
One-time consumables for surgery	30,513	29,948	0.7489	30,436	29,796	0.7548
Total cost of hospitalization	68,594	67,504	0.7442	69,870	66,942	0.4817
Hospital stay	15.42	15.75	0.6922	15.47	15.50	0.9813

Abbreviations: LS, liner stapler; CS, circle stapler; ASA staging, American Society of Anesthesiology staging; ECOG, Eastern Cooperative Oncology Group performance status.

Table 3 Demographic or Characteristic Date of the Patient in Primary Cohort and Validation Cohort

Demographic or Characteristic	Primary Cohort N=363	Validation Cohort N=108
Age	66.02	65.36
Gender
Male	268	76
Female	95	32
Preoperative BMI	22.88	22.61
Preoperative albumin	37.25	36.87
Preoperative hemoglobin	118.2	117.8
Hypertension
Yes	127	37
No	236	71
Diabetes
Yes	47	16
No	316	92
Cardiopulmonary
Yes	27	9
No	336	99
Renal impairment
Yes	8	3
No	355	105
ASA staging
I	190	56
II	150	47
III	23	5
IV	0	0
V	0	0
VI	0	0
ECGO
0	253	78
1	103	28
2	7	2
3	0	0
4	0	0
5	0	0
Stapler
LS	72	20
CS	291	88
Blood transfusion
Yes	135	65
No	228	43
Jejunal feeding tube
Yes	94	78
No	269	30
Operation time	228.7	220.8
Tumor long diameter	5.091	4.901
Tumor short diameter	3.767	3.707
Vascular invasion
Yes	134	36
No	229	72
Nerve invasion
Yes	162	48
No	201	60
T stage
1–2	55	14
3–4	308	94
Number of total lymph nodes	22.15	22.41
Number of positive lymph nodes	5.603	5.750
One-time consumables for surgery	30,384	31,593
Total cost of hospitalization	67,754	68,040
Hospital stay	15.71	15.35
Complication
Yes	43	11
No	320	97

Abbreviations: BMI, body mass index; LS, liner stapler; CS, circle stapler; ASA staging, American Society of Anesthesiology staging; ECOG, Eastern Cooperative Oncology Group performance status.

Table 4 Univariate and Multivariable Analysis of Factors Influencing Early Postoperative Complications of Total Gastrectomy for Gastric Cancer

Factors	Univariate Analysis		Multivariate Analysis
	OR (95% CI)	P	OR	P
Stapler		0.000		0.030
CS	1		1
LS	3.547 (1.810,6.950)		2.501 (1.095,5.716)
Age	1.068 (1.026,1.113)	0.001	1.052 (1.007,1.098)	0.024
Blood transfusion		0.000		0.021
No	1		1
Yes	2.961 (1.547,5.748)		2.450 (1.147,5.234)
One-time consumables for surgery	1.000 (1.000,1.001)	0.001	1.000 (1.000,1.001)	0.022
Number of total lymph nodes	1.091 (1.052,1.132)	0.001	1.060 (1.014,1.109)	0.011
Number of positive lymph nodes	1.101 (1.060,1.114)	0.001	1.054 (1.005,1.104)	0.029

Abbreviations: LS, liner stapler; CS, circle stapler.

Figure 4 The nomogram for predicting the risk of early postoperative complications of total gastrectomy for gastric cancer. Cost, one-time consumables for surgery. LymphNodes, number of total lymph nodes. PositivelymphNodes, number of positive lymph nodes.

Figure 5 Calibration plots of primary cohort.

Notes: The y-axis is the actual rate. The x-axis is the predicted risk. The diagonal dotted line represents a perfect prediction by an ideal model. The solid line represents the bias-corrected performance of the nomogram, where a closer fit to the diagonal dotted line represents a better prediction.

Figure 6 Calibration plots of modeling cohort.

Figure 7 Calibration plots of validation cohort.