The Aortic Calcification Index is a risk factor associated with anastomotic leakage after anterior resection of rectal cancer

Abstract

Aim Anastomotic leakage (AL) is one of the most feared postoperative complications after anterior resection (AR) of rectal cancer. An adequate blood supply at the anastomotic site is regarded as a prerequisite for healing. We hypothesize that the Aortic Calcification Index (ACI) might reflect the severity of atherosclerosis in patients, and thereby be a risk factor for AL. Method AL was investigated retrospectively according to the definition of the International Study Group of Rectal Cancer in 423 rectal cancer patients who underwent anterior rectal resection. The ACI was measured by preoperative abdominal CT scan. The cross‐section of the aorta was evenly divided into 12 sectors, the number of calcified sectors was counted as the calcification score of each slice. Lasso logistic regression and multivariate regression analysis were used to identify risk factors for AL. Results The percentage of AL after AR was 7.8% (33/423); the mortality of patients who sustained a leak was 3.0% (1/33). Patients with a high ACI had a significantly higher percentage of AL than patients with low ACI (11.2% vs 5.6%, P = 0.04). Among patients with AL, a higher ACI was associated with greater severity of AL (the ACI of patients with grade A leakage, grade B leakage and grade C leakage was 0.5% ± 0.2%, 11.5% ± 9.2% and 24.2% ± 21.7%, respectively; P = 0.008). After risk adjustment, multivariate regression analysis showed that a higher ACI was an independent risk factor for AL (OR 2.391, P = 0.04). Conclusion A high ACI might be an important prognostic factor for AL after AR for rectal cancer. Confirmatory studies are required.

Aortic calcification is associated with non-infective rather than infective postoperative complications following colorectal cancer resection: an observational cohort study

“…In colorectal surgery, the accepted leak rate is below 10% [39]. Leak rates in colorectal studies examining AC have ranged from 8 to 22% [17][18][19][20]22]. The leak rate was low at 5% among the 562 patients who underwent a primary anastomosis in this cohort.…”

“…One study of patients undergoing CRC resection in Iran reported a leak rate of 20% but included only patients with ASA grades 1 or 2 in whom CVD risk is likely to be low [17]. Shen and colleagues reported a leak rate of 7.8% among 423 Chinese patients undergoing rectal cancer resection and found an independent relationship between AC and leak [22]. In addition to the lower incidence of radiographically-detectable vascular calcification in Asian populations [8], the authors highlighted the low predictive value of the AC threshold derived in this cohort, suggesting the reported relationship with leak is not directly comparable to patients from Europe and North America.…”

“…The presence of major AC was prognostic of anastomotic leak following oesophagectomy in both discovery [15] and validation [16] cohorts. However, studies in patients undergoing colorectal resection have been hampered by small sample sizes, inclusion of patients undergoing emergency surgery and differences in the underlying pathology, operative indication and technique, all of which influence complication rates [17][18][19][20][21][22].…”

Aorta Calcification Increases the Risk of Anastomotic Leakage After Gastrectomy in Gastric Cancer Patients

“…5,12 Vascular calcification has been implicated as an independent risk factor for anastomotic leakage after esophageal and colorectal cancer surgery. 13,14 Vascular calcification might affect the blood supply of the anastomosis, 13 thus leading to anastomotic leakage. To our knowledge, there is no previous research related to vascular calcification and anastomotic leakage in gastric cancer in previously published studies.…”

Calcification of the Aorta-Iliac Trajectory as a Risk Factor for Anastomotic Leakage in Colorectal Surgery: Individual Patient Data Meta-Analysis and Systematic Review

“…Komen et al and Shen et al both found a correlation between aorta-iliac calcification and AL. 16,17 Vascular calcification has been investigated using computed tomography (CT) imaging software. 16 Furthermore, the assessment of vascular calcium, including local stenosis with CT scans in multiple trajectories, has been a topic of research.…”