Risk Factors Analysis and Nomogram Prediction Model for Postoperative Bile Leakage After Hepatic Cystic Echinococcosis Surger

Abstract

Objective: To investigate the independent risk factors for bile leakage (BL) after hepatic cystic echinococcosis (HCE) surgery and to construct an individualized nomogram prediction model. Methods: A retrospective analysis was conducted on HCE patients who underwent surgical treatment at the Department of Hepatobiliary Surgery from January 2018 to December 2023. Postoperative bile leakage was defined according to the International Study Group of Liver Surgery (ISGLS) criteria. Least absolute shrinkage and selection operator (LASSO) regression was used for variable selection, and a nomogram was constructed based on multivariate logistic regression. Model discrimination was assessed using receiver operating characteristic (ROC) curve, calibration was evaluated using calibration curve, and clinical utility was assessed using decision curve analysis (DCA). Internal validation was performed using the full dataset with 1000-repetition bootstrap resampling. Results: A total of 120 HCE patients were included, with postoperative bile leakage occurring in 14 patients (11.7%). LASSO regression identified four predictors. Multivariate logistic regression revealed that cyst diameter ≥9.0 cm (OR=4.14, 95%CI: 1.63-10.52, P=0.003), perihilar cyst location (OR=4.62, 95%CI: 1.71-12.48, P=0.002), preoperative GGT >85 U/L (OR=2.95, 95%CI: 1.12-7.76, P=0.028), and pericystectomy versus liver resection (OR=3.82, 95%CI: 1.45-10.06, P=0.007) were independent risk factors. The nomogram achieved an AUC of 0.812 (95%CI: 0.724-0.900), with a bootstrap-corrected C-index of 0.783 (95%CI: 0.710-0.852). The calibration curve demonstrated good agreement (Hosmer-Lemeshow test P=0.672), and DCA indicated clinical utility. Conclusion: The nomogram based on cyst diameter ≥9.0 cm, perihilar location, preoperative GGT >85 U/L, and pericystectomy can effectively predict the risk of bile leakage after HCE surgery, providing a reference for individualized clinical decision-making.