Universität zu Köln

Chang, De-Hua, Brinkmann, Sebastian, Smith, Lucy, Becker, Ingrid ORCID: 0000-0001-5829-3553, Schroeder, Wolfgang, Hoelscher, Arnulf H., Haneder, Stefan, Maintz, David and Spiro, Judith Eva (2018). Calcification score versus arterial stenosis grading: comparison of two CT-based methods for risk assessment of anastomotic leakage after esophagectomy and gastric pull-up. Therap. Clin. Risk Manag., 14. S. 721 - 728. ALBANY: DOVE MEDICAL PRESS LTD. ISSN 1178-203X

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Abstract

Purpose: Anastomotic leakage is a major surgical complication following esophagectomy and gastric pull-up. Specific risk factors such as celiac trunk (TC) stenosis and high calcification score of the aorta have been identified, but no data are available on their relative prognostic values. This retrospective study aimed to compare and evaluate calcification score versus stenosis quantification with regards to prognostic impact on anastomotic leakage. Patients and methods: Preoperative contrast-enhanced computed tomography scans of 164 consecutive patients with primary esophageal cancer were evaluated by two radiologists to apply a calcification score (0-3 scale) assessing the aorta, the celiac axis and the right and left postceliac arteries. Concurrently, the presence and degree of stenosis of TC and superior mesenteric artery were recorded for stenosis quantification. Results: Anastomotic leakage was noted in 14/164 patients and 12/14 showed stenosis of TC (n=11). The presence of TC stenosis was found to have a significant impact on anastomotic healing (p=0.004). The odds ratio for the prediction of anastomotic leakage by the degree of stenosis was 1.04 (95% CI, 1.02-1.07). Ten of 14 patients had aortic calcification scores of 1 or 2, but calcification scores of the aorta, the celiac axis and the right and left postceliac arteries did not correlate with the corresponding TC stenosis values and showed no influence on patient outcome as defined by the occurrence of anastomotic insufficiency (p=0.565, 0.855, 0.518 and 1.000, respectively). Inter-reader reliability of computed tomography analysis and absolute agreement on calcium scoring was mostly over 90%. No significant differences in preoperative comorbidities and patient characteristics were found between those with and without anastomotic leakage. Conclusion: Measurement of TC stenosis in preoperative contrast-enhanced computed tomography scans proved to be more reliable than calcification scores in predicting anastomotic leakage and should, therefore, be used in the risk assessment of patients undergoing esophagectomy and gastric pull-up.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Chang, De-Hua UNSPECIFIED UNSPECIFIED UNSPECIFIED Brinkmann, Sebastian UNSPECIFIED UNSPECIFIED UNSPECIFIED Smith, Lucy UNSPECIFIED UNSPECIFIED UNSPECIFIED Becker, Ingrid UNSPECIFIED orcid.org/0000-0001-5829-3553 UNSPECIFIED Schroeder, Wolfgang UNSPECIFIED UNSPECIFIED UNSPECIFIED Hoelscher, Arnulf H. UNSPECIFIED UNSPECIFIED UNSPECIFIED Haneder, Stefan UNSPECIFIED UNSPECIFIED UNSPECIFIED Maintz, David UNSPECIFIED UNSPECIFIED UNSPECIFIED Spiro, Judith Eva UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-202986
DOI:	10.2147/TCRM.S157352
Journal or Publication Title:	Therap. Clin. Risk Manag.
Volume:	14
Page Range:	S. 721 - 728
Date:	2018
Publisher:	DOVE MEDICAL PRESS LTD
Place of Publication:	ALBANY
ISSN:	1178-203X
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language PREOPERATIVE CHEMORADIOTHERAPY; TUBE; COMPLICATIONS; MANAGEMENT; INCREASES; CANCER; FLOW Multiple languages Health Care Sciences & Services Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/20298