Predicting Anastomotic Leak After Neoadjuvant Chemoimmunotherapy and Esophagectomy: A Dynamic Inflammatory and
Zhenyuan Yang1,2,3,4, Yizhou Huang1,2,3,4, Maohui Chen1,2,3,4
1Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, People's Republic of China.
Purpose:
To determine the incidence of anastomotic leak (AL) following esophagectomy after neoadjuvant immunochemotherapy (NICT) for esophageal squamous cell carcinoma (ESCC) and to develop a novel prediction model integrating dynamic inflammatory and nutritional biomarkers.
Patients And Methods:
This two-center, retrospective study enrolled 550 patients (350 in training cohort, 200 in external validation cohort) with locally advanced ESCC who underwent NICT followed by esophagectomy. For each inflammatory and nutritional index, we calculated the change (Δ) from before NICT to before surgery. Multivariable logistic regression was used to identify independent predictors and construct the prediction model for AL. Model performance was assessed by area under the curve (AUC), calibration, and decision curve analysis.
Results:
The incidence of AL was 10.57% (training) and 11.50% (validation). Most leaks were cervical (93.33%), of Grade II/III severity (78.33%), and nearly half led to anastomotic stenosis (46.67%). The final prediction model incorporated ΔNPR_cat, ΔPAR_cat, ΔHALP_cat and two clinical variables (BMI < 18.5 kg/m2, ECOG performance status ≥ 1). The model demonstrated good discrimination, with an AUC of 0.797 (95% CI: 0.714-0.881) in the training cohort, which was confirmed in the external validation cohort (AUC=0.730, 95% CI: 0.629-0.832). Calibration plots showed good agreement between predicted and observed probabilities.
Conclusion:
AL remains a significant complication after NICT and esophagectomy. We established and validated a practical prediction model that dynamically integrates biomarker trajectories and clinical factors. This tool may help identify high-risk patients preoperatively and thereby support the implementation of tailored perioperative strategies, such as intensified monitoring, proactive nutritional support, or selective anastomotic protection measures.