A Nomogram for Predicting Anastomotic Stricture after Laparoscopic Radical Resection of Rectal Cancer.

Abstract

Background: Anastomotic stricture is a common complication following laparoscopic radical resection of rectal cancer, affecting up to 30% of patients and significantly impacting quality of life. This study aimed to develop a predictive model to identify high-risk patients and characterize stricture subtypes. Methods: Retrospective analysis of 304 patients undergoing laparoscopic rectal cancer resection (August 2019-April 2024) identified independent risk factors through multivariate logistic regression. A nomogram was developed and validated using receiver operating characteristic curves, calibration plots, and decision curve analysis. Subtype analysis compared Type I (dilatable, n = 51) and Type II (refractory, n = 38) strictures. Results: The nomogram incorporated five independent predictors: preoperative radiotherapy (odd ratio [OR] = 4.13), diverting stoma creation (OR = 6.98), lack of left colic artery preservation (OR = 3.95), anastomotic leakage (OR = 16.53), and anastomotic distance ≤3 cm (OR = 4.02), achieving an area under the curve (AUC) of .827. Type I strictures were significantly associated with diverting stoma creation (82.4% versus 39.5%, P = .004) and an anastomotic distance >3 cm (70.6% versus 36.8%, P = .001). The refined nomogram for Type II strictures demonstrated superior discrimination (AUC = .883, P < .001). Conclusion: This dual-phase nomogram effectively predicts overall anastomotic stricture risk and identifies refractory subtypes, enabling personalized postoperative management.