Department of Gastrointestinal Surgery and Liver Transplant, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110025, India.
Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.
J Gastrointest Cancer. 2023 Sep;54(3):759-767. doi: 10.1007/s12029-022-00856-6. Epub 2022 Aug 15.
Cervical esophagogastric anastomotic leak (CEGAL) is a troublesome complication after esophagectomy and gastric pull-up. The aim of the study was to identify the preoperative clinical and radiological factors associated with increased risk of CEGAL.
Consecutive patients whose clinical and imaging data were available and who underwent cervical esophago-gastric anastomosis following esophagectomy and gastric pull-up for esophageal cancer, between January 2013 and January 2021, were included. The patient details were collected from a prospectively maintained database. The demographic, clinical, and laboratory data including preoperative hemoglobin and serum albumin levels were recorded. Preoperative computed tomographic (CT) images were reviewed by two independent radiologists to assign vascular calcification scores for proximal aorta, distal aorta, aortic bifurcation, celiac trunk, and celiac artery branches. The primary outcome evaluated was clinically evident neck leak. Univariate and multivariate analysis of the clinical and radiological factors was performed to identify significant predictors.
A total of 100 patients (mean age: 54.7 years; 60 males, 40 females) were included in the study and of them, 27 developed CEGAL. Compared to the group without CEGAL, the patient group with CEGAL had significantly higher mean age (60.3 vs. 52.7 years, p < 0.01), and higher incidences of diabetes mellitus (25.9% vs 10.9%, p = 0.03), major proximal aortic calcification (29.6% vs. 6.3%, p < 0.01), and major celiac trunk calcification (22.2% vs. 6.3%, p = 0.02). Multivariate regression analysis identified age and presence of major proximal aortic calcification as independent risk factors for the development of CEGAL.
Major calcification of the proximal aorta and advanced age are independent risk factors for CEGAL after esophagectomy.
颈胃吻合口瘘（CEGAL）是食管癌切除和胃上提术后的一种麻烦的并发症。本研究旨在确定与 CEGAL 风险增加相关的术前临床和影像学因素。
连续纳入 2013 年 1 月至 2021 年 1 月期间在我院行食管癌切除和胃上提术，并进行颈胃吻合术的患者。收集患者的详细信息，包括人口统计学、临床和实验室数据，包括术前血红蛋白和血清白蛋白水平。术前计算机断层扫描（CT）图像由两名独立的放射科医生进行回顾，以对近端主动脉、远端主动脉、主动脉分叉、腹腔干和腹腔动脉分支的血管钙化评分进行赋值。主要结局为临床明显的颈部漏。对临床和影像学因素进行单因素和多因素分析，以确定显著预测因子。
共纳入 100 例患者（平均年龄：54.7 岁；60 名男性，40 名女性），其中 27 例发生 CEGAL。与无 CEGAL 组相比，CEGAL 组患者的平均年龄明显较高（60.3 岁 vs. 52.7 岁，p < 0.01），且糖尿病发生率较高（25.9% vs. 10.9%，p = 0.03），近端主动脉重度钙化发生率较高（29.6% vs. 6.3%，p < 0.01），腹腔干重度钙化发生率较高（22.2% vs. 6.3%，p = 0.02）。多因素回归分析确定年龄和近端主动脉重度钙化的存在是 CEGAL 发生的独立危险因素。
近端主动脉重度钙化和高龄是食管癌切除术后发生 CEGAL 的独立危险因素。
