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| Establishment and verification of a nomogram for anastomotic leakage after esophageal cancer resection |
| Bai Chengyun, Li Zhongcheng, Li Wenjun, Liu Yang |
| Department of Thoracic Surgery Affiliated Hospital of Qinghai University Xining 810001 Qinghai China |
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Abstract Objective To establish a nomogram predictive model for anastomotic leakage in patients with resectable esophageal
cancer after radical resection and verify it. Method A method of retrospective case - control study was conducted a total of 588
patients with cT1-3
/ N0-1
esophageal cancer diagnosis undergoing radical resection into Affiliated Hospital of Qinghai University from
August 2015 to August 2020 were included as the model group. In which 52 patients of anastomotic leakage and other 536 patients of
non - anastomotic leakage were diagnosed according to the definition of anastomotic leakage proposed by the esophagectomy
complications consensus group ECCG . Lasso regression and multivariate Logistic regression analysis were used to screen risk factors
and R software was used to construct a nomogram model. Result In the model group the smoking index≥400 and ASA classification
III of patients with anastomotic leakage were higher than those without anastomotic leakage tumor location of the upper and middle part
was more surgery time was longer the minimally invasive method was more the linear stapled and Hand-sewn were more the neck
anastomosis was more the jejunostomy and nasal-intestinal canal were more and prognostic nutritional index PNI was lower too
P < 0. 05 . Lasso regression screening identified the 5 most differential indicators multivariate Logistic regression analysis showed
that smoking index ≥ 400 OR = 1. 659 95% CI = 1. 210 - 1. 969 P = 0. 006 ASA grade Ⅲ OR = 1. 968 95% CI =
1. 524-2. 326 P = 0. 002 Hand-sewn anastomosis OR = 3. 002 95% CI = 2. 526- 3. 425 P < 0. 001 neck anastomosis
OR = 2. 201 95% CI = 1. 625-2. 458 P = 0. 001 PNI < 50 OR = 3. 652 95% CI = 3. 120-3. 968 P < 0. 001 were the
independent predictor of anastomotic leakage. The nomogram predictive model was constructed by R software. Receiver operating curve
ROC showed that the area under the curve AUC was 0. 899 which was significantly higher than the AUC value of every single risk
factor all P < 0. 001 . The corrective curve showed that the predictive result was in good agreement with actual result P = 0. 663 .
Conclusion The occurrence of anastomotic leakage in patients with resectable esophageal cancer after radical resection is closely related to multiple clinical factors. The construction of a quantitative nomogram model has good predictive efficiency which is convenient to
guide the early identification of high-risk patients and targeted intervention and has good clinical application value.
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Received: 07 February 2023
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