Journal of pediatric surgery · 2026
Primary radical surgery or preoperative drainage? A clinical decision framework for pediatric choledochal cysts.
СтатьяНазвание и аннотация: Перевод в очереди
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Yang Zhenhua, Wu Peng, Zhou Jun, Jiang Bin, Fu Yanhang, Huang Lei
Аннотация
BACKGROUND: For children with complicated choledochal cyst (CDC), the decision between primary radical surgery (PRS) and preoperative drainage (PD) remains subjective. We aimed to develop an objective preoperative risk framework to inform this choice.
METHODS: A retrospective, single-center review of 454 children with CDCs was conducted. The primary outcome was disease-related severe complications (Clavien-Dindo ≥ II). A prediction model for severe complications was built using logistic regression. A sensitivity analysis used a composite outcome that also included extreme surgical difficulty (prolonged operative time plus prolonged hospital stay). A point score was derived from the composite-outcome analysis.
RESULTS: Severe complications occurred in 24 of 380 PRS patients (6.3%). Intrahepatic duct dilatation (OR 3.58, P = 0.005) and inflammation score ≥2 (OR 2.35, P = 0.058) were the main predictors. In the composite-outcome analysis (50 events), a simplified 11-point score (inflammation score, intrahepatic dilatation, hemoglobin) stratified patients into low- (0 points, 5.5%), medium- (1-3 points, 13.6%) and high-risk (≥4 points, 18.3%) groups. PD patients (n = 74) had a higher predicted risk of suboptimal outcome if they had undergone PRS (19.2% vs. observed 13.2% in PRS, P < 0.001).
CONCLUSIONS: A preliminary risk score using three preoperative variables can help identify children at higher risk of poor outcome after PRS. The tool requires external validation and should support, not replace, clinical judgment.
STUDY LEVEL OF EVIDENCE: Level III.
TYPE OF STUDY: Diagnostic/Prognostic.
METHODS: A retrospective, single-center review of 454 children with CDCs was conducted. The primary outcome was disease-related severe complications (Clavien-Dindo ≥ II). A prediction model for severe complications was built using logistic regression. A sensitivity analysis used a composite outcome that also included extreme surgical difficulty (prolonged operative time plus prolonged hospital stay). A point score was derived from the composite-outcome analysis.
RESULTS: Severe complications occurred in 24 of 380 PRS patients (6.3%). Intrahepatic duct dilatation (OR 3.58, P = 0.005) and inflammation score ≥2 (OR 2.35, P = 0.058) were the main predictors. In the composite-outcome analysis (50 events), a simplified 11-point score (inflammation score, intrahepatic dilatation, hemoglobin) stratified patients into low- (0 points, 5.5%), medium- (1-3 points, 13.6%) and high-risk (≥4 points, 18.3%) groups. PD patients (n = 74) had a higher predicted risk of suboptimal outcome if they had undergone PRS (19.2% vs. observed 13.2% in PRS, P < 0.001).
CONCLUSIONS: A preliminary risk score using three preoperative variables can help identify children at higher risk of poor outcome after PRS. The tool requires external validation and should support, not replace, clinical judgment.
STUDY LEVEL OF EVIDENCE: Level III.
TYPE OF STUDY: Diagnostic/Prognostic.