Development and validation of a nomogram for early prediction of splenic infarction after minimally invasive spleen-preserving distal pancreatectomy: A single-center retrospective cohort study.

Abstract

Minimally invasive spleen-preserving distal pancreatectomy is recognized as a standard procedure for benign pancreatic tumors but carries a substantial risk of splenic infarction. This study aimed to develop and validate an effective clinical model for risk prediction of splenic infarction after spleen-preserving distal pancreatectomy to guide clinical management. This retrospective cohort study analyzed 397 patients undergoing minimally invasive spleen-preserving distal pancreatectomy between January 2020 and June 2024. Patients were categorized into splenic infarction (n = 70) and nonsplenic infarction (n = 327) groups based on routine postoperative computed tomography findings within 3 days. Predictors were selected using least absolute shrinkage and selection operator regression, and a multivariate logistic regression was used to develop a predictive nomogram model. The model underwent internal validation (1,000 bootstrap resamples) and was evaluated using receiver operating characteristic curves, calibration plots, and decision curve analysis. Temporal validation was performed using a later, independent cohort (n = 156) from the same center. The research encompassed data from 397 consecutive patients who underwent minimally invasive spleen-preserving distal pancreatectomy. Univariate and multivariate analysis identified 4 independent predictors of splenic infarction: older age (odds ratio, 1.019; 95% confidence interval [CI], 1.001-1.038; P = .043), longer operative time (odds ratio, 1.008; 95% confidence interval, 1.004-1.012; P < .001), Warshaw technique (odds ratio, 4.304; 95% confidence interval, 2.257-8.208; P < .001), and laparoscopic approach (odds ratio, 2.051; P = .019). The nomogram demonstrated good discrimination with an area under the curve of 0.781 (95% confidence interval, 0.722-0.840) and was well calibrated (Hosmer-Lemeshow test, P = .502). Decision curve analysis confirmed the model's clinical utility across a wide threshold probability range. The temporal validation demonstrated that splenic infarction increases the risk of major postoperative complications (Clavien-Dindo grade ≥III). The validated nomogram effectively predicts the splenic infarction risk after minimally invasive spleen-preserving distal pancreatectomy, providing clinicians with a practical tool for guiding postoperative monitoring and personalizing patient management.