Objective To analyze risk factors for cervical anastomotic leakage after totally minimally invasive esophagectomy for esophageal cancer.

Methods Clinical data of 539 patients with esophageal cancer who underwent totally minimally invasive esophagectomy at The Fourth Hospital of Hebei Medical University from September 2013 to November 2021 were retrospectively analyzed. Multivariable Logistic regression analysis was employed to screen for risk factors associated with postoperative cervical anastomotic leakage.

Results Among 539 patients, cervical anastomotic leakage occurred in 99 cases, with an incidence rate of 18.37%. Univariable analysis revealed that American Society of Anesthesiologists (ASA) grade, liver cirrhosis, anastomotic location, and anastomotic technique were significantly associated with cervical anastomotic leakage (P < 0.05). Multivariable Logistic regression analysis demonstrated that liver cirrhosis (OR=2.006, 95% CI: 0.989 to 3.890, P=0.044) and manual anastomosis (OR=1.993, 95% CI: 1.140 to 2.842, P=0.046) were independent risk factors for cervical anastomotic leakage after totally minimally invasive esophagectomy.

Conclusion Attention to risk factors for cervical anastomotic leakage, optimization of perioperative management, and accumulation of surgical experience are crucial for preventing cervical anastomotic leakage following minimally invasive esophagectomy.