Impact of metabolic syndrome on postoperative anastomotic leakage following esophagectomy: development and validation of a predictive nomogram

Background Metabolic syndrome is a metabolic disorder, and its prevalence is constantly increasing. However, its impact on anastomotic leakage following esophagectomy remains controversial. This study aimed to evaluate the association between Metabolic syndrome and anastomotic leakage in patients undergoing radical resection for esophageal cancer. Methods Esophageal cancer patients who have received radical surgery between January 2023 and September 2025 were included. The primary outcome was anastomotic leakage, while the secondary outcomes were other complications. Univariate and multivariate analyses were performed to identify potential risk factors for anastomotic leakage. A nomogram for predicting anastomotic leakage was established, and its clinical significance was examined. Results A total of 261 patients were ultimately included in this study, which included 214 men and 47 women. The prevalence rate of metabolic syndrome was 33%. Metabolic syndrome is associated with a significantly increased incidence of anastomotic leakage (19.8% vs 9.7%, p = 0.023). However, metabolic syndrome did not increase the risk of other complications. Univariate and multivariate logistic regression analyses demonstrated that metabolic syndrome (odd ratio [OR] = 0.390, p = 0.029), postoperative C-reactive protein (CRP, OR = 1.013, p < 0.001), postoperative systemic immune-inflammation index (SII, OR = 1.000, p = 0.003), surgical approach (OR = 0.166, p = 0.040) were independently associated with anastomotic leakage after esophagectomy. We established a nomogram based on the independent predictive factors and evaluated its performance using the receiver operating characteristic (ROC) curve. The area under the curve (AUC) was 0.822, indicating a favorable predictive ability of the model. Conclusions Metabolic syndrome is independently associated with anastomotic leakage following esophagectomy. The nomogram, including metabolic syndrome, postoperative CRP, postoperative SII, and surgical approach, enabled accurate individualized prediction of postoperative anastomotic leakage. Trial registration: Not applicable.