Objective Anastomotic leakage (AL) remains a major complication following laparoscopic surgery for rectal cancer (RC). This study aimed to evaluate whether preoperative serum albumin (ALB), hemoglobin (Hb), and total serum calcium (Ca) can predict the risk of AL and to construct and externally validate a nomogram for individualized risk prediction. Methods In this retrospective, two-center cohort study, patients with RC who underwent elective laparoscopic resection with primary anastomosis between December 2018 and December 2022 were included. The training cohort comprised 560 patients from the Affiliated Cancer Hospital of Xinjiang Medical University, while the validation cohort included 187 patients from the People’s Hospital of Bortala Mongolian Autonomous Prefecture. The primary outcome was the occurrence of AL within 14 days postoperatively. Predictive performance was assessed using receiver operating characteristic (ROC) curve analysis. Independent predictors were identified using multivariable logistic regression, and a nomogram was subsequently developed and externally validated. Results AL occurred in 12.0% (67/560) of the training cohort and 11.2% (21/187) of the validation cohort. ALB, Hb, and Ca demonstrated moderate predictive ability (AUC 0.728–0.836), with a combined AUC of 0.870. An operative time of ≥180 min was identified as an independent risk factor (odds ratio OR, 3.86), whereas higher levels of ALB, Hb, and Ca were protective. The nomogram showed good discrimination (AUC 0.878 in training cohort; 0.911 in validation cohort) and satisfactory calibration. Conclusions A nomogram integrating operative time with preoperative ALB, Hb, and Ca provides a practical tool for stratifying the risk of AL after laparoscopic surgery for RC.
Wang et al. (Fri,) studied this question.