Lucas Goense1, Peter S N van Rossum1, Teus J Weijs2, Marc J van Det3, Grard A Nieuwenhuijzen2, Misha D Luyer2, Maarten S van Leeuwen4, Richard van Hillegersberg5, Jelle P Ruurda5, Ewout A Kouwenhoven6. 1. Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands. 2. Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands. 3. Department of Surgery, Ziekenhuisgroep Twente, Almelo, The Netherlands. 4. Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands. 5. Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. 6. Department of Surgery, Ziekenhuisgroep Twente, Almelo, The Netherlands. Electronic address: e.kouwenhoven@zgt.nl.
Abstract
BACKGROUND: Anastomotic leakage is associated with increased morbidity and mortality after esophagectomy. Calcification of the arteries supplying the gastric tube has been identified as a risk factor for leakage of the cervical anastomosis, but its potential contribution to the risk of intrathoracic anastomotic leakage has not been elucidated. This study evaluated the relationship between calcification and the occurrence of leakage of the intrathoracic anastomosis after Ivor-Lewis esophagectomy. METHODS: Consecutive patients who underwent minimally invasive esophagectomy for cancer at 2 institutions were analyzed. Diagnostic computed tomography images were used to detect calcification of the arteries supplying the gastric tube (eg, aorta, celiac axis). Multivariable logistic regression analysis was used to determine the relationship between vascular calcification and anastomotic leakage. RESULTS: Of 167 included patients, anastomotic leakage occurred in 40 (24%). In univariable analysis, leakage was most frequently observed in patients with calcification of the aorta (major calcification: 37% leakage [16 of 43]; minor calcification: 32% [18 of 56]; no calcification: 9% [6 of 70], p < 0.001). Calcification of other studied arteries was not significantly associated with leakage. A significant association with leakage remained for minor (odds ratio, 5.4; 95% confidence interval, 1.7 to 16.5) and major (odds ratio, 7.0; 95% confidence interval, 1.9 to 26.4) aortic calcifications in multivariable analysis. CONCLUSIONS: Atherosclerotic calcification of the aorta is an independent risk factor for leakage of the intrathoracic anastomosis after Ivor-Lewis esophagectomy for cancer. The calcification scoring system may aid in patient selection and lead to earlier diagnosis of this potentially fatal complication.
BACKGROUND:Anastomotic leakage is associated with increased morbidity and mortality after esophagectomy. Calcification of the arteries supplying the gastric tube has been identified as a risk factor for leakage of the cervical anastomosis, but its potential contribution to the risk of intrathoracic anastomotic leakage has not been elucidated. This study evaluated the relationship between calcification and the occurrence of leakage of the intrathoracic anastomosis after Ivor-Lewis esophagectomy. METHODS: Consecutive patients who underwent minimally invasive esophagectomy for cancer at 2 institutions were analyzed. Diagnostic computed tomography images were used to detect calcification of the arteries supplying the gastric tube (eg, aorta, celiac axis). Multivariable logistic regression analysis was used to determine the relationship between vascular calcification and anastomotic leakage. RESULTS: Of 167 included patients, anastomotic leakage occurred in 40 (24%). In univariable analysis, leakage was most frequently observed in patients with calcification of the aorta (major calcification: 37% leakage [16 of 43]; minor calcification: 32% [18 of 56]; no calcification: 9% [6 of 70], p < 0.001). Calcification of other studied arteries was not significantly associated with leakage. A significant association with leakage remained for minor (odds ratio, 5.4; 95% confidence interval, 1.7 to 16.5) and major (odds ratio, 7.0; 95% confidence interval, 1.9 to 26.4) aortic calcifications in multivariable analysis. CONCLUSIONS:Atherosclerotic calcification of the aorta is an independent risk factor for leakage of the intrathoracic anastomosis after Ivor-Lewis esophagectomy for cancer. The calcification scoring system may aid in patient selection and lead to earlier diagnosis of this potentially fatal complication.
Authors: Katrina A Knight; Chui Hon Fei; Kate F Boland; Daniel R Dolan; Allan M Golder; Donald C McMillan; Paul G Horgan; Douglas H Black; James H Park; Campbell S D Roxburgh Journal: Eur Radiol Date: 2020-11-17 Impact factor: 5.315
Authors: Sandra I Bril; Najiba Chargi; Thomas F Pezier; Bernard M Tijink; Weibel W Braunius; Ernst J Smid; Pim A de Jong; Remco de Bree Journal: Head Neck Date: 2021-11-10 Impact factor: 3.821
Authors: J A H Gooszen; L Goense; S S Gisbertz; J P Ruurda; R van Hillegersberg; M I van Berge Henegouwen Journal: Br J Surg Date: 2018-02-07 Impact factor: 6.939
Authors: De-Hua Chang; Sebastian Brinkmann; Lucy Smith; Ingrid Becker; Wolfgang Schroeder; Arnulf H Hoelscher; Stefan Haneder; David Maintz; Judith Eva Spiro Journal: Ther Clin Risk Manag Date: 2018-04-17 Impact factor: 2.423