Key result
Nomogram using male sex, tumor location, procalcitonin, and hemoglobin predicts anastomotic leakage with ~0.79 AUC.
Why the study?
Anastomotic leakage remains a major complication after laparoscopic radical colorectal cancer resection, associated with increased morbidity and prolonged hospitalization.
Cohort (n=268)
No
Effect estimate: OR 3.97 (95% CI 1.20-13.19)
p-value: p=0.031
A validated nomogram incorporating male sex, low tumor location, elevated postoperative procalcitonin, and decreased postoperative hemoglobin can effectively predict the individualized risk of anastomotic leakage after laparoscopic colorectal cancer surgery.
High-risk patients may benefit from enhanced surveillance for anastomotic leakage; extends prior models with postoperative biomarkers.
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. 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. 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. 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.
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He et al. (2026) conducted a cohort in Colorectal cancer (n=268). Laparoscopic radical colorectal cancer surgery was evaluated on Anastomotic leakage (Male sex as predictor) (OR 3.97, 95% CI 1.20-13.19, p=0.031). A nomogram incorporating male sex, low tumor location, elevated procalcitonin, and decreased hemoglobin predicted anastomotic leakage after laparoscopic colorectal surgery with an AUC of 0.785.
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