Vascular calcification does not predict anastomotic leak or conduit necrosis following oesophagectomy  

作　　者：Benjamin J Jefferies Emily Evans James Bundred James Hodson John L Whiting Colm Forde Ewen A Griffiths 

机构地区：[1]College of Medical and Dental Sciences,University of Birmingham,Birmingham B15 2TT,United Kingdom [2]Department of Radiology,University Hospitals Birmingham NHS Foundation Trust,Birmingham B15 2WB,United Kingdom [3]Institute of Translational Medicine,University Hospitals Birmingham NHS Foundation Trust,Birmingham B15 2TT,United Kingdom [4]Department of Upper Gastrointestinal Surgery,University Hospitals Birmingham NHS Foundation Trust,Birmingham B15 2TH,United Kingdom [5]Institute of Cancer and Genomic Sciences,University of Birmingham,Birmingham B15 2TT,United Kingdom

出　　处：《World Journal of Gastrointestinal Surgery》2019年第7期308-321,共14页世界胃肠外科杂志（英文版）（电子版）

摘　　要：BACKGROUND Anastomotic leaks(AL)and gastric conduit necrosis(CN)are serious complications following oesophagectomy.Some studies have suggested that vascular calcification may be associated with an increased AL rate,but this has not been validated in a United Kingdom population.AIM To investigate whether vascular calcification identified on the pre-operative computed tomography(CT)scan is predictive of AL or CN.METHODS Routine pre-operative CT scans of 414 patients who underwent oesophagectomy for malignancy with oesophagogastric anastomosis at the Queen Elizabeth Hospital Birmingham between 2006 and 2018 were retrospectively analysed.Calcification of the proximal aorta,distal aorta,coeliac trunk and branches of the coeliac trunk was scored by two reviewers.The relationship between these calcification scores and occurrence of AL and CN was then analysed.The Esophagectomy Complications Consensus Group definition of AL and CN was used.RESULTS Complication data were available in n=411 patients,of whom 16.7%developed either AL(15.8%)or CN(3.4%).Rates of AL were significantly higher in female patients,at 23.0%,compared to 13.9%in males(P=0.047).CN was significantly more common in females,(8.0%vs 2.2%,P=0.014),patients with diabetes(10.6%vs 2.5%,P=0.014),a history of smoking(10.3%vs 2.3%,P=0.008),and a higher American Society of Anaesthesiologists grade(P=0.024).Out of the 14 conduit necroses,only 4 occurred without a concomitant AL.No statistically significant association was found between calcification of any of the vessels studied and either of these outcomes.Multivariable analyses were then performed to identify whether a combination of the calcification scores could be identified that would be significantly predictive of any of the outcomes.However,the stepwise approach did not select any factors for inclusion in the final models.The analysis was repeated for composite outcomes of those patients with either AL or CN(n=69,16.7%)and for those with both AL and CN(n=10,2.4%)and again,no significant associations were deBACKGROUND Anastomotic leaks(AL) and gastric conduit necrosis(CN) are serious complications following oesophagectomy. Some studies have suggested that vascular calcification may be associated with an increased AL rate, but this has not been validated in a United Kingdom population.AIM To investigate whether vascular calcification identified on the pre-operative computed tomography(CT) scan is predictive of AL or CN.METHODS Routine pre-operative CT scans of 414 patients who underwent oesophagectomy for malignancy with oesophagogastric anastomosis at the Queen Elizabeth Hospital Birmingham between 2006 and 2018 were retrospectively analysed.Calcification of the proximal aorta, distal aorta, coeliac trunk and branches of the coeliac trunk was scored by two reviewers. The relationship between these calcification scores and occurrence of AL and CN was then analysed. The Esophagectomy Complications Consensus Group definition of AL and CN was used.RESULTS Complication data were available in n = 411 patients, of whom 16.7% developed either AL(15.8%) or CN(3.4%). Rates of AL were significantly higher in female patients, at 23.0%, compared to 13.9% in males(P = 0.047). CN was significantly more common in females,(8.0% vs 2.2%, P = 0.014), patients with diabetes(10.6%vs 2.5%, P = 0.014), a history of smoking(10.3% vs 2.3%, P = 0.008), and a higher American Society of Anaesthesiologists grade(P = 0.024). Out of the 14 conduit necroses, only 4 occurred without a concomitant AL. No statistically significant association was found between calcification of any of the vessels studied and either of these outcomes. Multivariable analyses were then performed to identify whether a combination of the calcification scores could be identified that would be significantly predictive of any of the outcomes. However, the stepwise approach did not select any factors for inclusion in the final models. The analysis was repeated for composite outcomes of those patients with either AL or CN(n =69, 16.7%) and for those with both AL and CN(n = 10,

关 键 词：OESOPHAGECTOMY Anastomotic LEAK Gastric CONDUIT NECROSIS CALCIFICATION Computed tomography ISCHAEMIA 

分 类 号：R[医药卫生]