Is abdominal vascular calcification score valuable in predicting the occurrence of colorectal anastomotic leakage? A meta-analysis

Tong, Lingling; Xie, Di; Song, Xiangping; Wu, Xin; Wen, Shi-Wu; Liu, Aizhong

doi:10.1007/s00384-020-03513-1

Cited by 5 publications

(7 citation statements)

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“…The clinical significance of aortic calcium scores and abdominal arteries has not been widely studied in the literature. A few authors studied atheroma as a risk factor for anastomosis leakage [19][20][21][22]25] or as being associated with the diameter of the main bile duct [26]. Our study suggests that among the abdominal arteries, calcifications of the superior mesenteric artery were the most strongly associated with mortality.…”

Section: Discussionmentioning

confidence: 62%

Atherosclerosis is associated with poorer outcome in non-occlusive mesenteric ischemia

Juif¹,

Calame²,

Winiszewski³

et al. 2021

European Journal of Radiology

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To evaluate whether abdominal atherosclerosis was associated with poorer outcome in a single-centre cohort of patients suffering from nonocclusive mesenteric ischemia (NOMI). Methods: From January 2009 to December 2019, 121 consecutive patients from the critical care unit who underwent laparotomy for suspected NOMI and with available unenhanced and contrast-enhanced CT were included. Clinical and biological data at the time of the CT scan were retrospectively extracted from medical charts and reviewed by a single radiologist. Unenhanced CT acquisitions were used to calculate calcium scores of the abdominal aorta, celiac trunk, superior mesenteric artery (SMA) and common iliac arteries according to the Agatston method. Univariate and multivariate analysis were performed. Results: Among the 121 patients with NOMI and calcium score calculation, only 4 patients had no aortic calcifications (3 %) and 32 had no superior mesenteric artery calcification (26 %). 35 patients (29 %) died within 24 h after the abdominal CT scan. Univariate analysis showed that a total abdominal calcium score greater than 15 000 (last quartile) was significantly associated with death within 24 h (14 (40 %) vs 17 (20 %) patients, p = 0.035). By multivariate analysis, a total abdominal calcium score greater than 15 000 was an independent risk factor for death (HR = 1.94,, p = 0.044). Regarding separate calcium scores, only a SMA calcium score greater than 50 was a risk factor for death (HR 2.46,, p = 0.019). Conclusion:Our results show that abdominal atherosclerosis, especially in the SMA, is associated with poorer outcome in NOMI.

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Section: Discussionmentioning

confidence: 62%

Atherosclerosis is associated with poorer outcome in non-occlusive mesenteric ischemia

Juif¹,

Calame²,

Winiszewski³

et al. 2021

European Journal of Radiology

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“…However, these methods were easily biased by some factors and new evaluation methods were needed. Preoperative malnutrition, serious inflammatory response and abdominal artery calcification might have an adverse effect on postoperative tissue healing (10,12,19,20), and these risk factors were included in this study to construct the nomogram.…”

Section: Discussionmentioning

confidence: 99%

“…The median BMI was 23.73 (range 14.61-34. 19). Tumors were distributed on right colon (n = 121, 41.44%), transverse colon (n = 12, 4.11%), left colon (n = 25, 8.56%), sigmoid colon (n = 58, 19.86%) and rectum (n = 76, 26.03%).…”

Section: Clinical Characteristics Of Patientsmentioning

confidence: 99%

“…The results of hematological tests were great indicators of preoperative systemic inflammation in patients with colorectal cancer, and the relevant data was readily available in almost all patients. Moreover, abdominal aorta calcification, which could damage the vascular function and might reduce anastomotic blood flow, might increase the risk of colorectal AL (19,20). Therefore, accurate preoperative assessment of the above risk factors was essential to prevent AL.…”

Section: Introductionmentioning

confidence: 99%

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A nomogram to predict the risk of colorectal anastomotic leakage combining inflammatory-nutritional and abdominal aorta calcium index

et al. 2023

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BackgroundAnastomotic leakage is a serious complication after colorectal cancer surgery, which affects the quality of life and the prognosis. This study aims to create a novel nomogram to predict the risk of anastomotic leakage for patients with colorectal cancer based on the preoperative inflammatory-nutritional index and abdominal aorta calcium index.Methods292 patients at Tianjin Medical University General Hospital (Tianjin, China) from January 2018 to October 2021 who underwent colorectal cancer surgery with a primary anastomosis were retrospectively reviewed. A nomogram was constructed based on the results of multivariate logistic regression model. The calibration curves and receiver operating characteristic curves were used to verify the efficacy of the nomogram.ResultsUnivariate and multivariate analyses showed that tumor location (P = 0.002), preoperative albumin (P = 0.006), preoperative lymphocyte (P = 0.035), preoperative neutrophil to lymphocyte ratio (P = 0.024), and superior mesenteric artery calcium volumes score (P = 0.004) were identified as the independent risk factors for postoperative anastomotic leakage in patients with colorectal carcinoma. A nomogram was constructed based on the results of the multivariate analysis, and the C-index of the calibration curves was 0.913 (95%CI: 0.870–0.957) in the training cohort and 0.840 (95%CI: 0.753–0.927) in the validation cohort.ConclusionThe nomogram, combining basic variables, inflammatory-nutritional index and abdominal aorta calcium index, could effectively predict the possibility of postoperative anastomotic leakage for patients with colorectal cancer, which could guide surgeons to carry out the appropriate treatment for the prevention of anastomotic leakage.

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“…Several recent studies demonstrated that atherosclerotic calcification of the aorta-iliac tract on preoperative CT-scan is associated with an increased risk of AL [12][13][14]. Although calcification in large arteries might mirror the anastomotic perfusion, the blood supply of the colorectal region is primary provided by the inferior mesenteric artery (IMA).…”

Section: Introductionmentioning

confidence: 99%

Mesenteric occlusive disease of the inferior mesenteric artery is associated with anastomotic leak after left-sided colon and rectal cancer surgery: a retrospective cohort study

Arron¹,

Broek²,

Adriaansens³

et al. 2022

Int J Colorectal Dis

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Purpose Anastomotic leak (AL) is a serious complication following colorectal surgery. Atherosclerosis causes inadequate anastomotic perfusion and is suggested to be a risk factor for AL. The aim of this study was to investigate the association of mesenteric occlusive disease on preoperative computed tomography (CT) scan with AL after left-sided colon or rectal cancer surgery. Methods This was a retrospective, multicenter cohort study including 1273 patients that underwent left-sided or rectal cancer resection between 2009 and 2018 from three hospitals in the Netherlands. AL patients were 1:1 matched with non-leak patients and preoperative contrast-enhanced CT-scans were retrospectively analyzed for mesenteric atherosclerotic lesions. The main outcome measure was the presence of mesenteric occlusive disease on the preoperative CT-scan. Results Anastomotic leak developed in 6% of 1273 patients (N = 76). Low anterior resection and stage I–III disease were statistically significant associated with AL (p = 0.01, p = 0.04). No other statistically significant differences in patient characteristics between AL and non-leak patients were found. A clinically significant stenosis (≥ 70–100%) of the inferior mesenteric artery was statistically significant more frequent present in AL patients, compared to non-leak patients (p < 0.01). No statistically significant differences in the presence of mesenteric occlusive disease of the celiac artery and superior mesenteric artery between AL patients and non-leak patients were found. Conclusion Mesenteric occlusive disease of the IMA on preoperative CT-scan is associated with AL after left-sided colon or rectal resection for cancer. Preoperative identification of high-risk patients with a preoperative CT-scan of the mesenteric vasculature might be useful to reduce the risk of AL.

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Is abdominal vascular calcification score valuable in predicting the occurrence of colorectal anastomotic leakage? A meta-analysis

Cited by 5 publications

References 50 publications

Atherosclerosis is associated with poorer outcome in non-occlusive mesenteric ischemia

Atherosclerosis is associated with poorer outcome in non-occlusive mesenteric ischemia

A nomogram to predict the risk of colorectal anastomotic leakage combining inflammatory-nutritional and abdominal aorta calcium index

Mesenteric occlusive disease of the inferior mesenteric artery is associated with anastomotic leak after left-sided colon and rectal cancer surgery: a retrospective cohort study

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