title: Calcification of arteries supplying the gastric tube: a new risk factor for anastomotic leakage after esophageal surgery.
abstract: To evaluate the association between the amount and location of calcifications of the supplying arteries of the gastric tube, as determined with a vascular calcification scoring system, and the occurrence of anastomotic leakage after esophagectomy with gastric tube reconstruction in patients with esophageal cancer.
  
  
  
  Institutional review board approval was obtained, and the informed consent requirement was waived for this retrospective study. Consecutive patients who underwent elective esophagectomy for cancer with gastric tube reconstruction and cervical anastomosis between 2003 and 2012 were identified from a prospective database. Vascular calcification scores were retrospectively assigned by reviewing the routine preoperative computed tomographic (CT) images. In patients with anastomotic leakage, presence and severity of calcifications of the aorta (score of 0-2), celiac axis (score of 0-2), right postceliac arteries (common hepatic, gastroduodenal, and right gastroepiploic arteries; score of 0-1), and left postceliac arteries (splenic and left gastroepiploic arteries, score of 0-1) along with patient- and procedure-related characteristics were compared with those of patients without leakage by using multivariate logistic regression analysis.
  
  
  
  Of 246 patients, 58 (24%) experienced anastomotic leakage. No significant differences in patient-related factors were found between patients with leakage and those without leakage, with the exception of more chronic use of steroids in the leakage group (7% [four of 58] vs 0% [0 of 188], P = .003). At univariate analysis, leakage was more common in patients with calcification of the aorta (27% [28 of 102] and 35% [13 of 37] vs 16% [17 of 107], P = .029) and the right postceliac arteries (55% [six of 11] vs 22% [52 of 235], P = .013). At multivariate analysis, both minor (odds ratio, 2.00; 95% confidence interval: 1.02, 3.94) and major (odds ratio, 2.87; 95% confidence interval: 1.22, 6.72) aortic calcifications were associated with leakage. Also, an independent association with leakage was found for calcifications of the right postceliac arteries (odds ratio, 4.22; 95% confidence interval: 1.24, 14.4).
  
  
  
  Atherosclerotic calcification of the aorta and right postceliac arteries that supply the gastric tube is an independent risk factor for anastomotic leakage after esophagectomy.
authors.affiliation: From the Department of Surgery (P.S.N.v.R., L.H., R.v.H., J.P.R.), Department of Radiotherapy (P.S.N.v.R.), Imaging Division (H.M.V.), and Department of Radiology (M.S.v.L.), University Medical Centre Utrecht, Heidelberglaan 100, 3584CX Utrecht, the Netherlands.
authors.forename: Peter S N
authors.initials: PSN
authors.lastname: van Rossum
authors.forename: Leonie
authors.initials: L
authors.lastname: Haverkamp
authors.forename: Helena M
authors.initials: HM
authors.lastname: Verkooijen
authors.forename: Maarten S
authors.initials: MS
authors.lastname: van Leeuwen
authors.forename: Richard
authors.initials: R
authors.lastname: van Hillegersberg
authors.forename: Jelle P
authors.initials: JP
authors.lastname: Ruurda
mesh_terms: D000368:Aged; D057868:Anastomotic Leak / Q000209:etiology*; D003287:Contrast Media; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D061205:Vascular Calcification / Q000150:complications* / Q000000981:diagnostic imaging*
chemical_list: D003287:Contrast Media