Related Experiment Video
Updated: Feb 14, 2026
An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function
Published on: April 17, 2020
Generalized cardiovascular disease on a preoperative CT scan is predictive for anastomotic leakage after
Alicia S Borggreve1, Lucas Goense1, Peter S N van Rossum2
1Department of Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584, CX Utrecht, The Netherlands; Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584, CX Utrecht, The Netherlands.
Insights
Arterial calcification in coronary and supra-aortic arteries predicts cervical anastomotic leakage after esophagectomy. This indicates generalized cardiovascular disease is a key risk factor for leakage following this procedure.
Area of Science:
- Cardiovascular Medicine
- Surgical Oncology
- Radiology
Background:
- Arterial calcification in gastric arteries is linked to anastomotic leakage post-esophagectomy.
- The role of generalized vascular disease versus local flow limitation in this association requires clarification.
Purpose of the Study:
- To investigate if calcification across the entire cardiovascular system predicts anastomotic leakage after esophagectomy with gastric tube reconstruction.
- To determine the association between widespread arterial calcification and cervical anastomotic leakage.
Main Methods:
- Analysis of consecutive patients undergoing esophagectomy with gastric tube reconstruction and cervical anastomosis.
- Quantification of arterial calcification in 10 locations using diagnostic CT scans and a visual grading system.
- Logistic regression analysis to assess the association between calcification and anastomotic leakage.
Main Results:
- Anastomotic leakage occurred in 25.6% of 406 patients.
- Calcification in coronary arteries, supra-aortic arteries, and thoracic aorta was significantly associated with leakage.
- Multivariable analysis confirmed independent associations between coronary artery calcification (minor) and supra-aortic artery calcification (minor/major) with leakage.
Conclusions:
- Routine CT assessment of coronary and supra-aortic artery calcification can predict cervical anastomotic leakage after esophagectomy.
- Generalized cardiovascular disease, indicated by arterial calcification, is a significant risk factor for anastomotic leakage.
Background:
Recent studies demonstrated that calcification of arteries supplying the gastric tube is associated with anastomotic leakage after esophagectomy. However, it remains unclear whether this association only derives from local flow limitations, or generalized vascular disease as well. The purpose of this study was to determine whether calcification throughout the entire cardiovascular system is associated with anastomotic leakage.
Methods:
Consecutive patients who underwent an esophagectomy with gastric tube reconstruction and cervical anastomosis for esophageal cancer were analyzed. Diagnostic CT images were scored for the presence of arterial calcification on 10 locations based on a visual grading system. The association with anastomotic leakage was studied using logistic regression analysis.
Results:
A total of 406 patients were included for analysis of whom 104 developed anastomotic leakage (25.6%). Presence of calcification in the coronary arteries (minor calcification: 36.5% leakage; no calcification: 18.1%, p = .001), supra-aortic arteries (minor calcification: 30.9% leakage; major calcification: 35.3%; no calcification: 16.1%, p = .007 and p < .001, respectively) and thoracic aorta (major calcification: 33.3% leakage; no calcification: 19.4%, p = .011) was associated with leakage. In multivariable analysis, minor calcification of the coronary arteries (OR 2.29, 95% CI: 1.28-4.12, p = .005) and calcification of the supra-aortic arteries (OR 2.48, 95% CI: 1.30-4.74, p = .006 for minor calcification and OR 2.72, 95% CI: 1.49-4.99, p = .001 for major calcification) remained independently associated with leakage.
Conclusions:
Calcification of the coronary and supra-aortic arteries on routine CT are predictive of cervical anastomotic leakage after esophagectomy. These results suggest that generalized cardiovascular disease is a strong indicator for the risk of leakage.
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