# Analysis of risk factors for anastomotic leakage after radical esophagectomy for esophageal squamous cell carcinoma

## TL;DR

This study identifies risk factors for anastomotic leakage after esophagectomy for esophageal cancer and creates a prediction model to help clinicians assess risk.

## Contribution

The study introduces a novel nomogram model and a mechanistic hypothesis for cervical anastomotic leakage.

## Key findings

- Age, anastomotic location, postoperative RBC count, and NLR are independent risk factors for anastomotic leakage.
- A nomogram model with an AUC of 0.870 was developed to predict AL risk.
- Cervical anastomotic leakage is linked to anastomotic tension and impaired perfusion.

## Abstract

Anastomotic leakage (AL) is one of the most common complications of radical surgery for esophageal cancer. This study aimed to analyze the risk factors for AL after radical esophagectomy for esophageal squamous cell carcinoma (ESCC) and construct a nomogram prediction model.

We retrospectively analyzed the clinical data of all patients who underwent radical esophagectomy between 2018 and 2023. Univariate and multivariable logistic regression analyses were used to identify the risk factors for AL. After screening the relevant variables, a prediction model for AL risk was established, and the predictive accuracy and clinical utility of the model were verified.

A total of 107 patients with ESCC were included and the incidence of AL was 21.5% (23/107). In multivariate logistic regression analysis, age (OR 1.131, 95% CI 1.014–1.261, p = 0.027), anastomotic location (OR 5.747, 95% CI 1.754–18.828, p = 0.004), postoperative red blood cell (RBC) (OR 0.152, 95% CI 0.042–0.543, p = 0.004), and postoperative neutrophil to lymphocyte ratio (NLR) level (OR 1.096, 95% CI 1.017–1.182, p = 0.016) were considered as independent risk factors for the occurrence of AL. Based on the results of the multivariate logistic regression analysis, a nomogram was constructed, and the area under the receiver operating characteristic (ROC) curve (AUC) was0.870. The decision curve analysis (DCA) demonstrated the clinical utility of this model.

Age, anastomotic location, postoperative RBC count, and postoperative NLR were independent risk factors for AL after radical esophagectomy for ESCC. In addition, this study innovatively provides the mechanistic hypothesis linking cervical AL to the combined effects of anastomotic tension and impaired perfusion, offering a pathophysiological basis for its higher incidence than thoracic anastomosis.