Evaluation of the Usefulness of Contrast-Enhanced Computed Tomography for the Early Detection of Anastomotic Leakage After Esophagectomy

Kazuhiko Morikawa; Yuichiro Tanishima; Takao Igarashi; Yohei Ohki; Keita Takahashi; Takanori Kurogochi; Fumiaki Yano; Hiroya Ojiri

doi:10.1097/RCT.0000000000001595

Evaluation of the Usefulness of Contrast-Enhanced Computed Tomography for the Early Detection of Anastomotic Leakage After Esophagectomy

J Comput Assist Tomogr. 2024 Feb 12. doi: 10.1097/RCT.0000000000001595. Online ahead of print.

Authors

Kazuhiko Morikawa¹, Yuichiro Tanishima², Takao Igarashi¹, Yohei Ohki¹, Keita Takahashi², Takanori Kurogochi², Fumiaki Yano², Hiroya Ojiri¹

Affiliations

¹ From the Department of Radiology and.
² Division of Gastrointestinal Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.

PMID: 38346793
DOI: 10.1097/RCT.0000000000001595

Abstract

Objective: Anastomotic leakage is one of the most severe complications after esophagectomy. However, a diagnostic gold standard for anastomotic leakage has not been established yet. This retrospective cohort study aimed to evaluate the potential use of routine postoperative contrast-enhanced computed tomography findings as an early predictor of anastomotic leakage in patients who underwent esophagectomy for esophageal cancer.

Methods: This study included 75 patients who underwent Mckeown esophagectomy, of whom 22 developed anastomotic leakage after surgery. The computed tomography findings for this patient cohort were categorized into 3 grades based on mural enhancement patterns observed at the anastomotic site. Both semiquantitative and quantitative analyses were performed, and the interobserver agreement between the 2 experienced radiologists was assessed.

Results: It was found that poor enhancement in both the early and portal venous phases (grade 2) had a robust association with the occurrence of anastomotic leakage. The computed tomography enhancement ratio that is used to estimate wall degeneration and ischemia was significantly higher in patients with anastomotic leakage.

Conclusions: Routine postoperative contrast-enhanced computed tomography could be beneficial for the early detection of anastomotic leakage, even in asymptomatic patients, after esophagectomy.