• Anastomotic leak
• Arterial calcifications
• CT imaging
• Esophageal cancer
• Esophagectomy
• Ivor Lewis

• Humans
• Male
• Retrospective Studies
• Female
• Aged
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Esophagectomy/adverse effects
• Esophagectomy/methods
• Vascular Calcification/complications
• Vascular Calcification/diagnostic imaging
• Vascular Calcification/surgery
• Middle Aged
• Reoperation/statistics & numerical data
• Coronary Artery Disease/surgery
• Coronary Artery Disease/complications
• Coronary Artery Disease/diagnostic imaging
• Patient Readmission/statistics & numerical data
• Coronary Vessels/surgery
• Coronary Vessels/diagnostic imaging
• Tomography, X-Ray Computed

• L40 CA253827 NCI NIH HHS
• P30 AG028740 NIA NIH HHS
• R33 AG056540 NIA NIH HHS

• Anastomotic leak
• Esophagectomy
• Gastric conduit ischemia
• Gastric conduit necrosis

• Humans
• Esophagectomy/adverse effects
• Ischemia/etiology
• Ischemia/diagnosis
• Postoperative Complications/prevention & control
• Postoperative Complications/diagnosis
• Stomach/blood supply
• Esophagus/blood supply
• Esophagus/surgery
• Esophageal Neoplasms/surgery

• esophageal cancer
• gastric tube reconstruction
• laparoscopic median arcuate ligament release
• median arcuate ligament syndrome
• submucosal invasion

• Anastomotic leak
• Conduit necrosis
• Oesophagectomy
• Outcomes

• Humans
• Esophagectomy
• Anastomotic Leak/epidemiology
• Anastomotic Leak/etiology
• Male
• Female
• Esophageal Neoplasms/surgery
• Esophageal Neoplasms/pathology
• Aged
• Middle Aged
• Necrosis
• Risk Factors
• Anastomosis, Surgical
• Risk Assessment
• Stomach/surgery
• Stomach/pathology
• ROC Curve
• Pulmonary Disease, Chronic Obstructive
• Body Mass Index
• Esophagus/surgery
• Esophagus/pathology

• Humans
• Liver Transplantation/adverse effects
• Liver Transplantation/methods
• Hepatic Artery/diagnostic imaging
• Hepatic Artery/surgery
• Constriction, Pathologic/complications
• Constriction, Pathologic/surgery
• Celiac Artery/diagnostic imaging
• Celiac Artery/surgery
• Thrombosis
• Biliary Tract
• Ligaments/diagnostic imaging
• Ligaments/surgery

• anastomotic leakage
• biomarkers
• c-reactive protein
• gastrointestinal cancer
• systematic review and meta-analysis

• Celiac axis
• Hepatectomy
• Hepatobiliary surgery
• Postoperative complication
• Stenosis

• Humans
• Carotid Stenosis/surgery
• Endarterectomy, Carotid/adverse effects
• Constriction, Pathologic/diagnostic imaging
• Retrospective Studies
• Risk Factors
• Postoperative Complications/diagnostic imaging
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Stents/adverse effects
• Treatment Outcome

• Universitätsklinikum Münster (8918)

• Esophagectomy
• Minimally invasive thoracoscopy
• Semi-mechanical triangular anastomosis
• Supine position

In orthotopic liver transplantation (OLT) recipients, median arcuate ligament syndrome (MALS) is considered a risk factor for hepatic arterial thrombosis (HAT), which is dreadful for OLT recipients. Different alternative surgical procedures have been proposed to overcome the impact of MALS on transplantation, but clinical evidence is still scarce.

To evaluate the feasible surgical management of MALS to reduce complications in OLT patients.

Data for 288 consecutive patients who underwent OLT at The First Hospital of Jilin University between January 2017 and July 2020 were retrospectively reviewed. The surgical management of median arcuate ligament (MAL) and modifications to the arterial anastomosis were recorded. The perioperative and long-term prognosis of MALS recipients were noted. Detailed preoperative and postoperative data of patients were analyzed in a descriptive manner.

Eight patients with MALS were included in this study. The first patient with MALS received no intervention during the primary surgery and developed postoperative HAT. Salvage liver transplantation with MAL division was successfully performed. Gastroduodenal artery (GDA) preservation with splenic artery ligation was performed on three patients, only GDA preservation was performed on two patients, and no intervention was performed on two patients. No patient developed HAT after surgery and postoperative recovery was satisfactory.

The preservation of collateral circulation between the superior mesenteric artery and celiac trunk via the GDA with or without splenic artery ligation is a safe and feasible alternative to MAL division.

• Orthotopic liver transplantation
• Median arcuate ligament syndrome
• Surgical complications
• Surgical management
• Hepatic artery thrombosis

• Anastomosis, Surgical/methods
• Anastomotic Leak/etiology
• Anastomotic Leak/surgery
• Esophageal Neoplasms/surgery
• Esophagectomy/adverse effects
• Esophagectomy/methods
• Humans
• Surgical Stapling
• Suture Techniques
• Treatment Outcome

Esophageal 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.

• Celiac artery stenosis
• Doppler ultrasonography
• Esophageal cancer
• Esophagectomy
• Median arcuate ligament

• Adrenalectomy
• Adrenocortical carcinoma
• Minimally invasive surgery
• Pheochromocytoma

• Computed tomography
• Diagnostic imaging
• Esophageal neoplasms
• Esophagectomy
• Postoperative complications

• Atheromatous stenosis
• Celiac axis
• Median arcuate ligament

(1) Background: The World Health Organization (WHO) regards atherosclerosis-related myocardial infarction and stroke as the main causes of death in humans. Susceptibility to atherogenesis-associated diseases is caused by single-nucleotide polymorphisms (SNPs). (2) Methods: Using our previously developed public web-service SNP_TATA_Comparator, we estimated statistical significance of the SNP-caused alterations in TATA-binding protein (TBP) binding affinity for 70 bp proximal promoter regions of the human genes clinically associated with diseases syntonic or dystonic with atherogenesis. Additionally, we did the same for several genes related to the maintenance of mitochondrial genome integrity, according to present-day active research aimed at retarding atherogenesis. (3) Results: In dbSNP, we found 1186 SNPs altering such affinity to the same extent as clinical SNP markers do (as estimated). Particularly, clinical SNP marker rs2276109 can prevent autoimmune diseases via reduced TBP affinity for the human MMP12 gene promoter and therefore macrophage elastase deficiency, which is a well-known physiological marker of accelerated atherogenesis that could be retarded nutritionally using dairy fermented by lactobacilli. (4) Conclusions: Our results uncovered SNPs near clinical SNP markers as the basis of neutral drift accelerating atherogenesis and SNPs of genes encoding proteins related to mitochondrial genome integrity and microRNA genes associated with instability of the atherosclerotic plaque as a basis of directional natural selection slowing atherogenesis. Their sum may be stabilizing the natural selection that sets the normal level of atherogenesis.

• TATA-binding protein (TBP) TBP-binding site (TATA box), single nucleotide polymorphism (SNP), candidate SNP marker
• atherosclerosis
• gene
• human
• promoter
• verification in vitro

• anastomotic leakage
• biomarkers
• upper gastrointestinal tract

Anastomotic leaks (AL) and gastric conduit necrosis (CN) are serious complications following oesophagectomy. Some studies have suggested that vascular calcification may be associated with an increased AL rate, but this has not been validated in a United Kingdom population.

To investigate whether vascular calcification identified on the pre-operative computed tomography (CT) scan is predictive of AL or CN.

Routine pre-operative CT scans of 414 patients who underwent oesophagectomy for malignancy with oesophagogastric anastomosis at the Queen Elizabeth Hospital Birmingham between 2006 and 2018 were retrospectively analysed. Calcification of the proximal aorta, distal aorta, coeliac trunk and branches of the coeliac trunk was scored by two reviewers. The relationship between these calcification scores and occurrence of AL and CN was then analysed. The Esophagectomy Complications Consensus Group definition of AL and CN was used.

Complication data were available in n = 411 patients, of whom 16.7% developed either AL (15.8%) or CN (3.4%). Rates of AL were significantly higher in female patients, at 23.0%, compared to 13.9% in males (P = 0.047). CN was significantly more common in females, (8.0% vs 2.2%, P = 0.014), patients with diabetes (10.6% vs 2.5%, P = 0.014), a history of smoking (10.3% vs 2.3%, P = 0.008), and a higher American Society of Anaesthesiologists grade (P = 0.024). Out of the 14 conduit necroses, only 4 occurred without a concomitant AL. No statistically significant association was found between calcification of any of the vessels studied and either of these outcomes. Multivariable analyses were then performed to identify whether a combination of the calcification scores could be identified that would be significantly predictive of any of the outcomes. However, the stepwise approach did not select any factors for inclusion in the final models. The analysis was repeated for composite outcomes of those patients with either AL or CN (n = 69, 16.7%) and for those with both AL and CN (n = 10, 2.4%) and again, no significant associations were detected. In the subset of patients that developed these outcomes, no significant associations were detected between calcification and the severity of the complication.

Calcification scoring was not significantly associated with Anastomotic Leak or CN in our study, therefore should not be used to identify patients who are high risk for these complications.

• Oesophagectomy
• Anastomotic leak
• Gastric conduit necrosis
• Calcification
• Computed tomography
• Ischaemia

• Aspiration
• Chylothorax
• Esophageal leak
• Esophageal stricture
• Feeding access

Median arcuate ligament compression (MALC) potentially causes arterial complications in orthotopic liver transplantation (OLT). Here we aimed to investigate the incidence of MALC and its impact on clinical outcome after OLT. In addition, we performed an international survey among 52 European liver transplant centers to explore local protocols on the management of these patients. Data of 286 consecutive OLT recipients from a prospective database were analyzed retrospectively (05/2010-07/2017). Preoperative computed-tomography images were evaluated. Celiac axis stenosis due to MALC was found in 34 patients (12%). Intrinsic stenosis was present in 16 (6%) patients. Twenty-six patients (77%) with MALC underwent standard arterial revascularization with median arcuate ligament (MAL)-division. Patients treated for MALC had comparable baseline data and no difference was found in early- and long-term outcome compared to the rest of our cohort. Our survey found heterogeneous strategies regarding diagnosis and treatment of MALC. Only 29% of the centers reported the division of MAL in these patients as routine procedure. Even though there is no consensus on diagnosis and management of MALC among European centers, a surgical division of MAL is feasible and safe and should be considered in OLT recipients with MALC.

• Dunbar syndrome
• MALS
• clinical outcome
• median arcuate ligament syndrome
• orthotopic liver transplantation
• surgical complications

Esophageal conduit ischaemia and necrosis is an uncommon but devastating complication of esophagectomy and remains one of the most challenging issues in surgical practice. The incidence, time interval to develop symptoms, and clinical presentation are highly variable with no predictable pattern. Evidence comes from case reports and case series rather than randomized controlled trials. We describe the issues surrounding conduit necrosis affecting the stomach, jejunum and colon as an esophageal replacement and the advantages, disadvantages and challenges of each type of reconstruction. Diagnosis is challenging for the most experienced surgeon. Upper gastrointestinal endoscopy and computed tomography thorax with both oral and intravenous contrast is the gold standard. Management, either conservative or interventional is also a difficult decision. Management options include conservative treatment and more aggressive treatments such as stent insertion, surgical debridement and repair of the esophagus using jejunum, colon or a musculocutaneous flap. In spite of recent advances in surgical techniques, there is no reliable strategy to manage esophageal conduit necrosis. Our review covers the pathophysiology and clinical significance of esophageal necrosis while highlighting current techniques of prevention, diagnosis and treatment of this life-threatening condition.

• Esophagectomy
• Esophageal cancers
• Esophagogastric anastomosis

• Chemoradiotherapy
• Chemotherapy
• Esophageal cancer
• Prognosis
• Surgery

• Chemoradiotherapy
• Combined Modality Therapy
• Drug Therapy
• Esophageal Neoplasms/mortality
• Esophageal Neoplasms/pathology
• Esophageal Neoplasms/therapy
• Humans
• Neoplasm Recurrence, Local
• Prognosis
• Surgical Procedures, Operative