To analyze the risk factors for postoperative anastomotic leakage (AL) and construct a corresponding risk prediction model in patients who underwent radical resection for rectal cancer after neoadjuvant chemoradiotherapy.

The clinical data of 29 patients who developed AL within 30 days after radical rectal resection following neoadjuvant chemoradiotherapy from January 2021 to January 2024 were selected and assigned to the AL group; another 131 patients without AL were enrolled as the non-AL group. Statistical analyses were performed using SPSS 24.0 software. Measurement data were expressed as mean (

The AL group had significantly higher proportions of patients with diabetes history, operative duration ≥ 3 hours, non-preservation of the left colic artery, tumor distance from the anal verge < 6 cm, and preoperative serum albumin < 35 g/L than the non-AL group. The levels of C-reactive protein, white blood cell and procalcitonin in the AL group were also markedly elevated relative to the non-AL group (P<0.05). Multivariate analysis demonstrated that operative duration ≥ 3 hours, non-preservation of the left colic artery, tumor distance from the anal verge < 6 cm, elevated C-reactive protein, and preoperative serum albumin < 35 g/L were independent risk factors for postoperative AL in rectal cancer patients (P<0.05). The nomogram model yielded a concordance index (C-index) of 0.885 (95%CI: 0.834~0.937) and an area under the curve (AUC) of 0.896 (95%CI: 0.848~0.942), with a specificity of 67.9% and a sensitivity of 93.1%.

Operative duration, preservation status of the left colic artery, tumor distance from the anal verge, C-reactive protein level and preoperative serum albumin are influencing factors of postoperative AL for rectal cancer patients receiving radical resection after neoadjuvant chemoradiotherapy. The nomogram model constructed based on these indicators exhibits excellent predictive value.