Calcification of arteries supplying the gastric tube increases the risk of anastomotic leakage after esophagectomy with cervical anastomosis

Abstract

Background: Anastomotic leak is an important cause of morbidity and mortality after esophagectomy for esophageal cancer patients. Calcification of the arteries supplying the gastric tube has been found to be associated with leakage after esophagectomy with cervical anastomosis in Europeans. The purpose of this study is to evaluate the association between calcifications of the supplying arteries of the gastric tube and the occurrence of anastomotic leakage after esophagectomy with cervical anastomosis in Chinese patients with esophageal cancer. Methods:The demographic, clinical, and pathological features as well as the vascular calcification of arteries of 709 esophageal cancer patients who had undergone esophagectomies with cervical anastomosis were analyzed. Univariable and multivariable logistic regression were used to identify the association between the postoperative anastomotic leakage and calcifications of the arteries supplying the gastric tube.Results: Among the 709 patients, 122 (17.2%) had developed anastomotic leakage. Thirty-day mortality and length of hospital stay were higher for patients with anastomotic leakage. Upper digestive tract ulcer, peripheral vascular disease, renal insufficiency, American society of Anesthesiologists (ASA) risk class, and calcifications of aorta and celiac axis were found to be independent risk factors for the anastomotic leakage.Conclusions: Calcification of the aorta and celiac axis that supply the gastric tube is an independent risk factor for cervical anastomotic leakage after esophagectomy in Chinese esophageal cancer patients.

Calcification score versus arterial stenosis grading: comparison of two CT-based methods for risk assessment of anastomotic leakage after esophagectomy and gastric pull-up

“…No correlation, however, could be found between arterial calcification scores and anastomotic leakage despite contrary findings in the literature. 9 , 22 , 25 Larger prospective studies are clearly needed to further explore and substantiate our findings. With regards to clinical implication, we recommend that patients scheduled for esophagectomy undergo routine preoperative screening for TC stenosis in order to identify those with an increased risk for anastomotic leakage.…”

“…Arterial calcification of the blood vessels supplying the gastric tube has been identified as an independent risk factor for leakage after esophagectomy with cervical anastomosis. 22 Calcifications of the aorta and the right postceliac arteries were found to be independent risk factors for anastomotic insufficiency. 9 The calcification scoring system evaluated in this study was developed by van Rossum et al by adapting a validated visual grading system for arterial abnormalities found on CT scans to predict cardiovascular events.…”

Surgical treatment of esophageal cancer in the era of multimodality management

“…In the context of risk factor evaluation, a patients’ vascular status can be objectively evaluated by arterial calcification on a CT scan. Patients with arterial calcifications have a higher risk of developing anastomotic leakage and esophageal conduit necrosis after esophagectomy compared with patients without calcifications . Preoperative identification of these high‐risk patients could aid in selecting patients who would potentially benefit from ischemic conditioning of the gastric conduit to reduce anastomotic leakage rates …”

“…Patients with arterial calcifications have a higher risk of developing anastomotic leakage and esophageal conduit necrosis after esophagectomy compared with patients without calcifications. [16][17][18][19] Preoperative identification of these high-risk patients could aid in selecting patients who would potentially benefit from ischemic conditioning of the gastric conduit to reduce anastomotic leakage rates. 20,21 Some studies suggest that diabetes mellitus is associated with impaired anastomotic healing and thus increases the risk of anastomotic leakage after esophagectomy.…”

Recent Advances in Minimally Invasive Esophagectomy

“…Drainage of the fistula through the cervical wound reduces the risk of sepsis, and the association of the enteral nutrition through the alimentary jejunostomy decreases the risk of postoperative mortality. The occurrence of anastomotic fistula is determined by certain specific risk factors for esophageal cancer and cervical anastomosis: malnutrition, neoadjuvant therapy, ischemia and atherosclerosis of the gastric conduit supply arteries, anastomosis technique, anastomosis tension, number of esophagectomy/year or the size of the upper thoracic aperture (69)(70)(71)(72).…”