Risk factors for anastomotic leakage after laparoscopic colorectal cancer surgery and development of a nursing early-warning model

BACKGROUNDAnastomotic leakage is a serious and relatively common complication of abdominal surgery, particularly gastrointestinal surgery.It may cause severe malnutrition, metabolic disturbances, and fluid, electrolyte, and acid-base imbalances, thereby compromising surgical outcomes and prognosis. AIMTo identify risk factors for anastomotic leakage after laparoscopic colorectal cancer surgery and develop a nursing early-warning model to support clinical risk assessment and nursing care. METHODSThis retrospective study included 400 patients who underwent laparoscopic colorectal cancer surgery at Qingdao Municipal Hospital and Qingdao Hospital of University of Health and Rehabilitation Sciences between May 2022 and May 2025.According to the occurrence of anastomotic leakage within 5 postoperative days, patients were assigned to the leakage group (n = 38) or the non-leakage group (n = 362).Univariate analysis and multivariable logistic regression were used to identify independent risk factors.A nursing early-warning model was developed in R, and its discrimination and calibration were evaluated using receiver operating characteristic (ROC) and calibration curves, respectively.RESULTS Multivariable logistic regression identified the following independent risk factors for anastomotic leakage: Body mass index ≥ 28 kg/m², tumor distance from the anal verge < 5 cm, T3-T4 tumor stage, preoperative malnutrition, absence of prophylactic stoma 4 / 32 creation, and operative time > 3 hours (all P < 0.05).The ROC curve yielded an area under the curve of 0.819, and the calibration curve closely approximated the ideal curve, indicating good model performance.CONCLUSION Several factors were independently associated with anastomotic leakage after laparoscopic colorectal cancer surgery.The nomogram-based early-warning model incorporating these factors showed good discrimination and calibration and may help identify patients at increased postoperative risk.Prospective external validation is required before routine clinical use.