A Nomogram for Predicting Postoperative Anastomotic Leakage in Esophageal Cancer Patients After Esophagectomy: Development and Validation

Background Esophageal cancer is a prevalent malignancy, particularly in East Asia, with high morbidity and mortality rates. Postoperative anastomotic leakage (AL) is a major complication after esophagectomy, impacting recovery and prognosis. Early identification of high-risk patients is critical. Objectives To develop and validate a predictive nomogram for postoperative AL risk using LASSO-logistic regression to identify independent risk factors. Methods A retrospective cohort study was conducted on 850 esophageal cancer patients who underwent esophagectomy. Clinical data were collected, including variables such as hypertension, C-reactive protein (CRP), operation time, lymphocyte-to-monocyte ratio (LMR), and tumor location. LASSO regression was used for variable selection, followed by multivariate logistic regression to identify independent risk factors. A nomogram was developed and validated in a separate cohort. Results Six independent risk factors for AL were identified: hypertension, neoadjuvant therapy, CRP, operation time, LMR, and tumor location. The nomogram showed good performance, with an AUC of 0.820 in the training cohort and 0.786 in the validation cohort, indicating strong discrimination. Calibration curves confirmed good agreement between predicted and observed outcomes. Conclusions The nomogram provides an effective and reliable tool for early risk stratification and individualized management of esophageal cancer patients at high risk for postoperative AL.