Abstract: Objective To investigate the risk factors for cervical anastomotic leakage after esophagectomy of esophageal cancer,and to establish a predictive nomogram model and verify its predictive ability.Methods A total of 623 patients diagnosed with esophageal cancer and treated with esophagectomy in the affiliated cancer hospital of Nantong university from January 2019 to December 2022 were selected and randomly divided into the modeling set group (n=428) and the validation set group (n=195) in a ratio of 7∶3.The patients in the modeling set group were divided into 2 groups based on the incidences of cervical anastomotic leakage.The baseline clinical data of 2 groups were collected and compared,and the risk factors of cervical anastomotic leakage were analyzed by multivariate Logistic regression.The nomogram model was constructed by R software and its accuracy was verified.The internal and external validation were conducted.Results Among the 428 patients with esophageal cancer in the modeling group,8.18% (35/428) had cervical anastomotic leakage after esophagectomy.The proportion of patients with hypertension,diabetes,neoadjuvant therapy,upper esophageal tumor,postoperative albumin ≤30 g/L and postoperative hypoxemia in the anastomotic leakage group were significantly higher than those in the non-anastomotic leakage group (P＜0.05).Multivariate Logistic regression analysis showed that neoadjuvant therapy,upper esophageal tumor,postoperative albumin ≤30 g/L and postoperative hypoxemia were independent risk factors for cervical anastomotic leakage after esophagectomy of esophageal cancer (P＜0.05).The C-index of the modeling set and validation set were 0.873 (95%CI:0.781-0.965) and 0.887 (95%CI:0.744-0.972),respectively.The calibration curves of 2 groups fitted well with the standard curve.The receiver operating characteristic curve (ROC) analysis of 2 groups showed that the area under the curve (AUC) was 0.811 (95%CI：0.738-0.865) and 0.825 (95%CI:0.720-0.913),,respectively,showing good prediction accuracy.Conclusion Establishing a nomogram model based on neoadjuvant therapy,upper esophageal tumor,postoperative albumin≤30 g/L and postoperative hypoxemia can accurately predict the risk for cervical anastomotic leakage after esophagectomy of esophageal cancer.

Key words: esophageal cancer, cervical anastomotic leakage, risk factors, nomogram