Vascular calcification does not predict anastomotic leak or conduit necrosis following oesophagectomy

Abstract

BACKGROUNDAnastomotic leaks (AL) and gastric conduit necrosis (CN) are serious complications following oesophagectomy. Some studies have suggested that vascular calcification may be associated with an increased AL rate, but this has not been validated in a United Kingdom population.AIMTo investigate whether vascular calcification identified on the pre-operative computed tomography (CT) scan is predictive of AL or CN.METHODSRoutine pre-operative CT scans of 414 patients who underwent oesophagectomy for malignancy with oesophagogastric anastomosis at the Queen Elizabeth Hospital Birmingham between 2006 and 2018 were retrospectively analysed. Calcification of the proximal aorta, distal aorta, coeliac trunk and branches of the coeliac trunk was scored by two reviewers. The relationship between these calcification scores and occurrence of AL and CN was then analysed. The Esophagectomy Complications Consensus Group definition of AL and CN was used.RESULTSComplication data were available in n = 411 patients, of whom 16.7% developed either AL (15.8%) or CN (3.4%). Rates of AL were significantly higher in female patients, at 23.0%, compared to 13.9% in males (P = 0.047). CN was significantly more common in females, (8.0% vs 2.2%, P = 0.014), patients with diabetes (10.6% vs 2.5%, P = 0.014), a history of smoking (10.3% vs 2.3%, P = 0.008), and a higher American Society of Anaesthesiologists grade (P = 0.024). Out of the 14 conduit necroses, only 4 occurred without a concomitant AL. No statistically significant association was found between calcification of any of the vessels studied and either of these outcomes. Multivariable analyses were then performed to identify whether a combination of the calcification scores could be identified that would be significantly predictive of any of the outcomes. However, the stepwise approach did not select any factors for inclusion in the final models. The analysis was repeated for composite outcomes of those patients with either AL or CN (n = 69, 16.7%) and for those with both AL and CN (n = 10, 2.4%) and again, no significant associations were detected. In the subset of patients that developed these outcomes, no significant associations were detected between calcification and the severity of the complication.CONCLUSIONCalcification scoring was not significantly associated with Anastomotic Leak or CN in our study, therefore should not be used to identify patients who are high risk for these complications.

Role of Radiology in the Preoperative Detection of Arterial Calcification and Celiac Trunk Stenosis and Its Association with Anastomotic Leakage Post Esophagectomy, an Up-to-Date Review of the Literature

“…Of the remaining 34 articles that underwent full-text evaluation, 25 were excluded for the following reasons: 1 case report of 2 patients [ 33 ], 1 systematic review [ 28 ], 1 systematic review and meta-analysis [ 29 ], and 22 articles which were assessed as irrelevant. Finally, 9 original studies fulfilled the inclusion criteria and were further scrutinized [ 30 , 31 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ]. The PRISMA flow diagram of the literature search and study selection is shown in Figure 3 .…”

Arterial calcification is a risk factor for anastomotic leakage after esophagectomy: A systematic review and meta-analysis

“…In contrast with other publications, Jefferies et al found no association between calcification and anastomotic leak rate [18]. Five of seven studies used the calcium score described by van Rossum et al [12,13,15,16,18]. The calcium score (0e2) contains the following descriptions: 0 (calcification absent), 1 (minor calcification), 2 (major calcification) [12].…”

“…Brinkmann et al and Chang et al found an association between celiac axis stenosis and anastomotic leakage [16,17]. In contrast with other publications, Jefferies et al found no association between calcification and anastomotic leak rate [18]. Five of seven studies used the calcium score described by van Rossum et al [12,13,15,16,18].…”

“…The study by Jefferies et al which did not discriminate between intrathoracic and cervical anastomosis was excluded for the subgroup analysis [18]. Three studies, containing Figs.…”

“…Van Rossum et al found that arterial calcification was associated with the presence of anastomotic leakage in patients after esophagectomy with gastric tube reconstruction [12]. Whilst some studies confirmed this observation [13e17], Jefferies et al did not [18].…”