Abstract
Simple SummaryEsophageal cancer is the sixth deadliest among all cancers worldwide. Multimodal treatment, including surgical resection of the esophagus, offers the potential for cure even in advanced cases, but esophagectomy is still associated with serious complications. Among these, anastomotic leakage has the most significant clinical impact, both in terms of prognosis and health-related quality of life. Identifying patients at a high risk for leakage is of great importance in order to modify their treatment and, if possible, avoid this complication. This review aims to study the current literature regarding the role of radiology in detecting potential risk factors associated with anastomotic leakage. The measurement of calcium plaques on the aorta, as well as the detection of narrowing of the celiac trunk and its branches, can be easily assessed by preoperative computed tomography, and can be used to individualize perioperative patient management to effectively reduce the rate of leakage.Surgical resection of the esophagus remains a critical component of the multimodal treatment of esophageal cancer. Anastomotic leakage (AL) is the most significant complication following esophagectomy, in terms of clinical implications. Identifying risk factors for AL is important for modifying patient management and improving surgical outcomes. This review aims to examine the role of radiological risk factors for AL after esophagectomy, and in particular, arterial calcification and celiac trunk stenosis. Eligible publications prior to 25 August 2021 were retrieved from Medline and Google Scholar using a predefined search algorithm. A total of 68 publications were identified, of which 9 original studies remained for in-depth analysis. The majority of these studies found correlations between calcifications in the aorta, celiac trunk, and right post-celiac arteries and AL following esophagectomy. Some studies suggest celiac trunk stenosis as a more appropriate surrogate. Our up-to-date review highlights the need for automated quantification of aortic calcifications, as well as the degree of celiac trunk stenosis in preoperative computed tomography in patients undergoing esophagectomy, to obtain robust and reproducible measurements that can be used for a definite correlation.
Highlights
Despite continuous diagnostic and therapeutic advancements, esophageal and gastroesophageal junction carcinoma remains a major cause of cancer-related mortality worldwide [1]
The majority of the studies included in this review indicate that arterial calcification and celiac trunk stenosis are associated with an increased risk for Anastomotic leakage (AL) after esophagectomy with gastric conduit (GC) reconstruction
The presence of studies that do not reproduce the aforementioned association generates questions to be answered and issues for further assessment. This up-to-date literature review adds value to the previously published reviews by Knight et al [28] and Hoek et al [29] concerning the impact of arterial calcification in AL after esophagectomy, by including studies evaluating another radiological risk factor for AL, namely celiac trunk stenosis
Summary
Despite continuous diagnostic and therapeutic advancements, esophageal and gastroesophageal junction carcinoma remains a major cause of cancer-related mortality worldwide [1]. Transthoracic esophagectomy with gastric conduit (GC) reconstruction has been the standard surgical technique used for the treatment of esophageal cancer in specialized gastroesophageal oncologic centers [3]. Esophagectomy is performed by either the McKeown procedure with a cervical anastomosis, or the Ivor Lewis procedure with an intrathoracic anastomosis [6,7,8]. Another surgical approach, namely transhiatal esophagectomy with cervical anastomosis, is usually reserved for patients with distally located or junctional tumors and higher comorbidity, as it is less invasive, but this approach is associated with inferior oncological outcomes [9]. Various minimally invasive techniques have gained popularity as studies have demonstrated at least equal short-term postoperative outcomes and improved long-term survival [10,11,12]
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