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Background <p>Anastomotic leakage (AL) remains a major complication after laparoscopic radical colorectal cancer resection, associated with increased morbidity and prolonged hospitalization. This study sought to determine independent risk factors for AL and to develop a predictive nomogram.</p> Methods <p>We retrospectively analyzed 268 consecutive patients undergoing elective laparoscopic radical colorectal resection between January 2021 and December 2024. Anastomotic leakage was defined and graded per International Study Group of Rectal Cancer (ISREC) criteria. Demographic, tumor, and perioperative laboratory data were collected. Multivariate logistic regression identified independent predictors of AL. A nomogram incorporating these factors was constructed and internally validated by bootstrap sampling (<i>n</i> = 1,000). Discrimination was assessed by area under the receiver operating characteristic curve (AUC) and concordance index (C‑index), and calibration by Hosmer–Lemeshow test. Decision curve analysis (DCA) evaluated clinical utility.</p> Results <p>Anastomotic leakage occurred in 31 of 268 patients (11.6%). Multivariate analysis revealed four independent predictors: male sex (odds ratio [OR] 3.97; 95% confidence interval [CI] 1.20–13.19; <i>p</i> = 0.031), tumor distance from the anal verge &lt; 7&#xa0;cm (OR 2.55; 95% CI 1.11–5.70; <i>p</i> = 0.035), elevated postoperative procalcitonin (per ng/mL; OR 3.17; 95% CI 1.12–9.17; <i>p</i> = 0.036), and lower postoperative hemoglobin (per g/L; OR 4.15; 95% CI 1.15–15.10; <i>p</i> = 0.038). The nomogram achieved an AUC of 0.785 (95% CI 0.716–0.825) and a bootstrap‑corrected C‑index of 0.761. Calibration was satisfactory (Hosmer–Lemeshow χ² 2.75, <i>p</i> = 0.895). DCA showed net benefit across plausible threshold probabilities.</p> Conclusions <p>Male sex, low tumor location, elevated postoperative procalcitonin, and decreased postoperative hemoglobin independently predict anastomotic leakage after laparoscopic colorectal cancer surgery. The validated nomogram offers individualized risk assessment to guide perioperative management.</p>

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Risk factor analysis and nomogram model development for anastomotic leakage following laparoscopic radical colorectal cancer surgery

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月25日

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  • Zi-Hong He,
  • Yang-Yang Zhou,
  • Ruo-Nan Zhang,
  • Yu-Shen He,
  • Yan-Hong Jin,
  • Fu-Hao Tian

摘要

Background

Anastomotic leakage (AL) remains a major complication after laparoscopic radical colorectal cancer resection, associated with increased morbidity and prolonged hospitalization. This study sought to determine independent risk factors for AL and to develop a predictive nomogram.

Methods

We retrospectively analyzed 268 consecutive patients undergoing elective laparoscopic radical colorectal resection between January 2021 and December 2024. Anastomotic leakage was defined and graded per International Study Group of Rectal Cancer (ISREC) criteria. Demographic, tumor, and perioperative laboratory data were collected. Multivariate logistic regression identified independent predictors of AL. A nomogram incorporating these factors was constructed and internally validated by bootstrap sampling (n = 1,000). Discrimination was assessed by area under the receiver operating characteristic curve (AUC) and concordance index (C‑index), and calibration by Hosmer–Lemeshow test. Decision curve analysis (DCA) evaluated clinical utility.

Results

Anastomotic leakage occurred in 31 of 268 patients (11.6%). Multivariate analysis revealed four independent predictors: male sex (odds ratio [OR] 3.97; 95% confidence interval [CI] 1.20–13.19; p = 0.031), tumor distance from the anal verge < 7 cm (OR 2.55; 95% CI 1.11–5.70; p = 0.035), elevated postoperative procalcitonin (per ng/mL; OR 3.17; 95% CI 1.12–9.17; p = 0.036), and lower postoperative hemoglobin (per g/L; OR 4.15; 95% CI 1.15–15.10; p = 0.038). The nomogram achieved an AUC of 0.785 (95% CI 0.716–0.825) and a bootstrap‑corrected C‑index of 0.761. Calibration was satisfactory (Hosmer–Lemeshow χ² 2.75, p = 0.895). DCA showed net benefit across plausible threshold probabilities.

Conclusions

Male sex, low tumor location, elevated postoperative procalcitonin, and decreased postoperative hemoglobin independently predict anastomotic leakage after laparoscopic colorectal cancer surgery. The validated nomogram offers individualized risk assessment to guide perioperative management.