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

Abstract

Surgical resection of the esophagus remains a critical component of the multimodal treatment of esophageal cancer. Anastomotic leakage (AL) is the most significant complication following esophagectomy, in terms of clinical implications. Identifying risk factors for AL is important for modifying patient management and improving surgical outcomes. This review aims to examine the role of radiological risk factors for AL after esophagectomy, and in particular, arterial calcification and celiac trunk stenosis. Eligible publications prior to 25 August 2021 were retrieved from Medline and Google Scholar using a predefined search algorithm. A total of 68 publications were identified, of which 9 original studies remained for in-depth analysis. The majority of these studies found correlations between calcifications in the aorta, celiac trunk, and right post-celiac arteries and AL following esophagectomy. Some studies suggest celiac trunk stenosis as a more appropriate surrogate. Our up-to-date review highlights the need for automated quantification of aortic calcifications, as well as the degree of celiac trunk stenosis in preoperative computed tomography in patients undergoing esophagectomy, to obtain robust and reproducible measurements that can be used for a definite correlation.

Short-term Outcomes of Different Techniques for Gastric Ischemic Pre-Conditioning Before Esophagectomy

“…Furthermore, not all the patients probably will benefit from GIC before esophagectomy, but it is likely that some high-risk individuals could be good candidates. 63,64 More specifically, patients with poor preoperative vascular status, major calcification of the thoracic aorta, and stenosis of the celiac axis could hypothetically benefit from GIC before esophagectomy. 65 To our knowledge, this is the first network analysis on this topic.…”

“…In the present meta-analysis, none of the included studies reported specific data on operating surgeons’ proficiency; therefore, results may be biased and should be interpreted prudently. Furthermore, not all the patients probably will benefit from GIC before esophagectomy, but it is likely that some high-risk individuals could be good candidates 63,64 . More specifically, patients with poor preoperative vascular status, major calcification of the thoracic aorta, and stenosis of the celiac axis could hypothetically benefit from GIC before esophagectomy 65…”

Development of a Novel Scoring Model to Estimate the Severity Grade of Mesenteric Artery Stenosis

“…However, this procedure is technically challenging and requires expertise in ultrasound imaging, visceral arterial hemodynamics, and duplex scan interpretation. On the other hand, CTA with 2D and 3D imaging can provide excellent reconstructions of the visceral arteries and is recommended as the initial imaging study in many studies [4,[27][28][29][30][31][32][33][34][35][36][37]. Furthermore, centerline analysis may be helpful in increasing the accuracy of the measurement of the stenosis and is especially appropriate for preoperative planning of endovascular treatment.…”