Analysis of Influencing Factors and Establishment of Nomogram Model for Textbook Outcome Achievement in Laparoscopic Resection of Hepatocellular Carcinoma

Jingxia Qiu,1 Hualian Pei,2 Qiongxi Shen,1 Jingjing Wang,1 Ximing Jiang,3 Jiyun Zhu,1 Xiaoqian Zhou,1 Xiaoping Yang,1 Haofen Xie4 1Hepatobiliary Surgery, The First Affiliated Hospital of Ningbo University, Ningbo City, Zhejiang Province, 315020, People’s Republic of China; 2Nursing Department, The First Affiliated Hospital of Ningbo, Ningbo City, Zhejiang Province, 315020, People’s Republic of China; 3The Medical Engineering Department, The First Affiliated Hospital of Ningbo University, Ningbo City, Zhejiang Province, 315020, People’s Republic of China; 4Outpatient Department, The First Affiliated Hospital of Ningbo University, Ningbo City, Zhejiang Province, 315020, People’s Republic of ChinaCorrespondence: Haofen Xie, Outpatient Department, The First Affiliated Hospital of Ningbo University, No. 247 Renmin Road, Jiangbei District, Ningbo City, Zhejiang Province, 315020, People’s Republic of China, Tel +86 13867889859, Email [email protected] Xiaoping Yang, Hepatobiliary Surgery, the First Affiliated Hospital of Ningbo University, No. 247 Renmin Road, Jiangbei District, Ningbo City, Zhejiang Province, 315020, People’s Republic of China, Email [email protected]: To analyse the influencing factors for textbook outcome (TO) achievement in laparoscopic hepatectomy for hepatocellular carcinoma (HCC) and to construct and validate a nomogram model.Methods: A total of 200 patients with HCC who underwent laparoscopic hepatectomy in our hospital between January 2022 and December 2024 were retrospectively analysed and divided into a TO group (n = 116) and a non-TO group (n = 84) according to the TO in liver surgery criteria. Twenty clinical parameters were collected, and after univariate analysis to screen variables, multivariate logistic regression was performed to determine independent influencing factors and establish nomograms. Model discrimination, calibration and clinical benefit were assessed using receiver operating characteristic (ROC) curves, calibration curves and decision curves.Results: Multivariate logistic analysis showed that no malnutrition before operation (odds ratio [OR] = 0.051; 95% confidence interval [CI]: 0.014– 0.179), intraoperative blood loss < 225 mL (OR = 0.096; 95% CI: 0.030– 0.310) and postoperative hospital stay < 12.5 days (OR = 0.061; 95% CI: 0.021– 0.182) were independent protective factors for TO (all P < 0.05). The nomogram C-index was 0.931; the area under the ROC curve was 0.983 (95% CI: 0.971– 0.995), sensitivity was 0.948 and specificity was 0.929; the calibration curve fitted well with the ideal curve; and the decision curve showed that the model had a significant positive net benefit. Subgroup analysis based on resection extent (minor vs major hepatectomy) confirmed the model’s robust performance, with AUCs of 0.984 and 0.976 respectively, demonstrating consistent predictive accuracy across different surgical complexities.Conclusion: Preoperative nutritional status, intraoperative blood loss and postoperative hospital stay are independent factors for achieving TO in laparoscopic resection of HCC. The constructed nomogram has excellent predictive performance and can be used to identify high-risk patients in the early clinical stage and guide individualised intervention.Keywords: hepatectomy, hepatocellular carcinoma, textbook outcome, influencing factors, nomogram model