The relationship between aortic calcification and anastomotic leak following gastrointestinal resection: a systematic review

Knight, K.A., Horgan, P.G. , McMillan, D.C. , Roxburgh, C.S.D. and Park, J.H. (2020) The relationship between aortic calcification and anastomotic leak following gastrointestinal resection: a systematic review. International Journal of Surgery, 73, pp. 42-49. (doi: 10.1016/j.ijsu.2019.11.023) (PMID:31765846)

Abstract

Anastomotic leak (AL) is a significant complication of gastrointestinal (GI) surgery. Impaired perfusion of the anastomosis is thought to play an important role. The degree of aortic calcification (AC) visible on preoperative CT imaging may be associated with an increased risk of AL following GI resection. This review assessed the relationship between AC and AL in patients undergoing GI resection. MEDLINE, EMBASE and the Cochrane library were systematically searched between 1946 and 2019. Relevant keywords were grouped to form a sensitive search strategy: surgical procedure (e.g. digestive system surgical procedure), calcification (e.g. vascular calcification, calcium score) and outcome (e.g. anastomotic leak). Studies assessing the degree of AC on preoperative imaging in relation to AL in adult patients requiring resection and anastomosis were included. The quality of each study was assessed using the Newcastle-Ottawa scale. Bias was assessed using the RevMan risk of bias tool. Nine observational studies were included: four in patients undergoing oesophageal resection (n=1446) and five in patients undergoing colorectal resection (n=556). AL occurred in 20% of patients following oesophagectomy and 14% of patients following colorectal resection. Adjustment for relevant confounders was limited in most studies. Two studies reported a relationship between the degree of AC and AL in patients undergoing oesophagectomy, independent of age and comorbidity. One study reported an association between AC and AL following colorectal resection, while three studies reported higher calcium scores in the iliac arteries of patients who developed colorectal AL. Overall study quality was moderate to good using the Newcastle-Ottawa scale. Detection and reporting bias was evident in the studies examining AL following colorectal resection. The current evidence suggests that the degree of AC may be associated with the development of AL, in particular in patients undergoing oesophagectomy. Further prospective data with adequate adjustment for confounders is required.

• Item Type: Articles
• Additional Information: The authors wish to thank Paul Cannon, College Librarian for Medical, Veterinary and Life Sciences at the University of Glasgow, for his assistance in developing the search strategy.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Park, Mr James and Horgan, Professor Paul and McMillan, Professor Donald and Roxburgh, Professor Campbell and Knight, Miss Katrina
• Authors: Knight, K.A., Horgan, P.G., McMillan, D.C., Roxburgh, C.S.D., and Park, J.H.
• College/School: College of Medical Veterinary and Life Sciences > School of Cancer Sciences; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: International Journal of Surgery
• Publisher: Elsevier
• ISSN: 1743-9191
• ISSN (Online): 1743-9159
• Published Online: 23 November 2019
• Copyright Holders: Crown Copyright © 2019
• First Published: First published in International Journal of Surgery 73:42-49
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher