Key result
Cervical anastomosis significantly increased the risk of anastomotic leakage compared to thoracic anastomosis (OR 5.747) in patients undergoing radical esophagectomy for esophageal squamous cell carcinoma.
Why the study?
Anastomotic leakage is a common complication after radical surgery for esophageal cancer, prompting the need to analyze risk factors and build a predictive nomogram.
Cohort (n=107)
No
Age, anastomotic location, postoperative RBC count, and postoperative NLR are independent risk factors for anastomotic leakage after radical esophagectomy for ESCC, which can be accurately predicted using a novel nomogram.
This is the authors' abstract. We don't add key points for this paper.
Objective 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. Methods 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. Results 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. Conclusion 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.
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Nomogram may refine AL risk stratification post-esophagectomy; hypothesis-generating and requires prospective validation before clinical adoption.
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Hu et al. (2025) conducted a cohort in Esophageal squamous cell carcinoma (ESCC) (n=107). Cervical anastomosis vs. Thoracic anastomosis was evaluated on Anastomotic leakage (OR 5.747, 95% CI 1.754-18.828, p=0.004). Cervical anastomosis significantly increased the risk of anastomotic leakage compared to thoracic anastomosis (OR 5.747) in patients undergoing radical esophagectomy for esophageal squamous cell carcinoma.
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