Diagnostic accuracy of early postoperative computed tomography imaging for anastomotic leakage after minimally...

Anastomotic leakage is a serious complication after minimally invasive esophagectomy and is associated with increased morbidity and mortality. Early diagnosis is crucial for enabling timely intervention and improving outcomes. Computed tomography imaging is performed when anastomotic leakage is suspected, but the diagnostic performance of early postoperative imaging remains uncertain.

Patients who underwent a minimally invasive Ivor Lewis esophagectomy for esophageal or proximal gastric cancer between 2015 and 2022 were retrospectively evaluated. Propensity score matching in a 2:1 ratio was applied to create comparable groups of patients with and without anastomotic leakage. The first postoperative computed tomography scan was independently reassessed by 3 radiologists.

A total of 639 patients underwent a minimally invasive esophagectomy during the study period, of whom 138 met the inclusion criteria. Fifty patients were included for radiological reassessment, including 32 without anastomotic leakage (N-AL group) and 18 with anastomotic leakage (AL group). Most patients were male in both groups, and the median age was 67 in the N-AL group and 68 years in the AL group. The first computed tomography scan was performed on postoperative day 4 in both groups. The sensitivity for detecting anastomotic leakage was 11.1%, and the specificity was 93.8%. Fat stranding and pneumothorax were observed more frequently in patients with anastomotic leakage. Radiological reassessment confidently classified 94.3% of patients without anastomotic leakage as not having anastomotic leakage.

Early postoperative computed tomography imaging reliably excluded anastomotic leakage but demonstrated limited sensitivity for detecting it. Multimodal diagnostic strategies integrating clinical assessment, biochemical markers, and imaging remain essential for timely diagnosis.