Generalized cardiovascular disease on a preoperative CT scan is predictive for anastomotic leakage after esophagectomy.

Abstract

BACKGROUND:

Recent studies demonstrated that calcification of arteries supplying the gastric tube is associated with anastomotic leakage after esophagectomy. However, it remains unclear whether this association only derives from local flow limitations, or generalized vascular disease as well. The purpose of this study was to determine whether calcification throughout the entire cardiovascular system is associated with anastomotic leakage.

METHODS:

Consecutive patients who underwent an esophagectomy with gastric tube reconstruction and cervical anastomosis for esophageal cancer were analyzed. Diagnostic CT images were scored for the presence of arterial calcification on 10 locations based on a visual grading system. The association with anastomotic leakage was studied using logistic regression analysis.

RESULTS:

A total of 406 patients were included for analysis of whom 104 developed anastomotic leakage (25.6%). Presence of calcification in the coronary arteries (minor calcification: 36.5% leakage; no calcification: 18.1%, p = .001), supra-aortic arteries (minor calcification: 30.9% leakage; major calcification: 35.3%; no calcification: 16.1%, p = .007 and p < .001, respectively) and thoracic aorta (major calcification: 33.3% leakage; no calcification: 19.4%, p = .011) was associated with leakage. In multivariable analysis, minor calcification of the coronary arteries (OR 2.29, 95% CI: 1.28-4.12, p = .005) and calcification of the supra-aortic arteries (OR 2.48, 95% CI: 1.30-4.74, p = .006 for minor calcification and OR 2.72, 95% CI: 1.49-4.99, p = .001 for major calcification) remained independently associated with leakage.

CONCLUSIONS:

Calcification of the coronary and supra-aortic arteries on routine CT are predictive of cervical anastomotic leakage after esophagectomy. These results suggest that generalized cardiovascular disease is a strong indicator for the risk of leakage.

• Authors: Alicia S Borggreve, Lucas Goense, Peter S N van Rossum, Richard van Hillegersberg, Pim A de Jong, Jelle P Ruurda
• Journal: European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology (Eur J Surg Oncol) Vol. 44 Issue 5 Pg. 587-593 (05 2018) ISSN: 1532-2157 [Electronic] England
• PMID: 29452856 (Publication Type: Journal Article)
• Copyright: Copyright © 2018 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

Topics

• Adenocarcinoma (surgery)
• Aged
• Anastomosis, Surgical
• Anastomotic Leak (epidemiology)
• Carcinoma, Squamous Cell (surgery)
• Cardiovascular Diseases (diagnostic imaging, epidemiology)
• Coronary Artery Disease (diagnostic imaging, epidemiology)
• Esophageal Neoplasms (surgery)
• Esophageal Squamous Cell Carcinoma
• Esophagectomy
• Female
• Humans
• Male
• Middle Aged
• Postoperative Complications (epidemiology)
• Risk Factors
• Tomography, X-Ray Computed
• Vascular Calcification (diagnostic imaging, epidemiology)