Aortic Calcification Increases the Risk of Anastomotic Leakage After Ivor-Lewis Esophagectomy.
Anastomotic leakage is associated with increased morbidity and mortality after esophagectomy. Calcification of the arteries supplying the gastric tube has been identified as a risk factor for leakage of the cervical anastomosis, but its potential contribution to the risk of intrathoracic anastomotic leakage has not been elucidated. This study evaluated the relationship between calcification and the occurrence of leakage of the intrathoracic anastomosis after Ivor-Lewis esophagectomy.



Consecutive patients who underwent minimally invasive esophagectomy for cancer at 2 institutions were analyzed. Diagnostic computed tomography images were used to detect calcification of the arteries supplying the gastric tube (eg, aorta, celiac axis). Multivariable logistic regression analysis was used to determine the relationship between vascular calcification and anastomotic leakage.



Of 167 included patients, anastomotic leakage occurred in 40 (24%). In univariable analysis, leakage was most frequently observed in patients with calcification of the aorta (major calcification: 37% leakage [16 of 43]; minor calcification: 32% [18 of 56]; no calcification: 9% [6 of 70], p < 0.001). Calcification of other studied arteries was not significantly associated with leakage. A significant association with leakage remained for minor (odds ratio, 5.4; 95% confidence interval, 1.7 to 16.5) and major (odds ratio, 7.0; 95% confidence interval, 1.9 to 26.4) aortic calcifications in multivariable analysis.



Atherosclerotic calcification of the aorta is an independent risk factor for leakage of the intrathoracic anastomosis after Ivor-Lewis esophagectomy for cancer. The calcification scoring system may aid in patient selection and lead to earlier diagnosis of this potentially fatal complication.
Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands.
Lucas
L
Goense
Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands.
Peter S N
PSN
van Rossum
Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
Teus J
TJ
Weijs
Department of Surgery, Ziekenhuisgroep Twente, Almelo, The Netherlands.
Marc J
MJ
van Det
Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
Grard A
GA
Nieuwenhuijzen
Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
Misha D
MD
Luyer
Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Maarten S
MS
van Leeuwen
Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Richard
R
van Hillegersberg
Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Jelle P
JP
Ruurda
Department of Surgery, Ziekenhuisgroep Twente, Almelo, The Netherlands. Electronic address: e.kouwenhoven@zgt.nl.
Ewout A
EA
Kouwenhoven
D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D001018:Aortic Diseases / Q000150:complications* / Q000175:diagnosis; D002114:Calcinosis / Q000150:complications* / Q000175:diagnosis; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects*; D009426:Netherlands / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed