151751-Najiba-Chargi

159 Surgery: skeletal muscle mass, arterial calcification and laryngectomy INTRODUCTION Total laryngectomy (TL) is a definitive treatment for patients with advanced stage laryngeal or pharyngeal cancer. It is also a salvage treatment option for patients with recurrent dis - ease after initial (chemo)radiotherapy, and can be used to treat patients with a dysfunctional larynx. 1,2 It is an invasive surgical procedure and is associated with frequent postoperative complications resulting in significant morbidity and mortality after surgery, compromising survival and quality of life. 3–5 Postoperative complications, including wound healing problems and the occurrence of a pharyngocutaneous fistula (PCF), are common and often difficult to treat. Approximately 30% of patients develops a PCF after TL, which often requires additional surgery, flap reconstruc - tion, increased hospital stay and prolonged feeding tube dependency. 6,7 Known risk factors for PCF are prior treatment with radiotherapy with concurrent platin-based chemotherapy, hypopharyngeal cancer, extensive pharyngeal resection and reconstruction, additional neck dissection, and low body mass index (BMI). Recently, radiologically assessed sarcopenia or low skeletal muscle mass has been identified as a novel risk factor for PCF and wound com - plications in patients undergoing total laryngectomy. 8,9 In recent years, it has been shown that routinely performed imaging, such as computed tomog- raphy (CT) scans, can be used to extract additional information on patient’s body composition as a biomarker of functional and biological status, as well as cancer specific features and risk factors. 10–12 The radiological assessment of sarcopenia is an example of this application. Specific for this research, routinely performed CT imaging can be used to measure arterial calcification as a biomarker for generalized cardiovascular disease. 13,14 In head and neck cancer patients, CT imaging of the head and neck area is commonly performed during the diagnostic work-up, on which the carotid arteries and vertebral arteries are shown. Additionally, thoracic CT imaging and/or whole-body PET-CT imaging may be performed, depending on local diag- nostic protocols, which provides imaging of the heart and aorta. Smoking, a known etiolog - ical factor for atherosclerosis, is common in head and neck cancer patients1 5 as is low-level persistent systemic inflammation, both of which are common in cancer patients.16, 17 For example in patients with esophageal cancer undergoing esophagectomy locoregional and generalized cardiovascular disease as identified on routine CT imaging is predictive of cervical anastomotic leakage. 18,19 The purpose of this study was to explore the extent of arterial calcifications present in patients undergoing TL, investigate whether the presence and burden of regional and generalized atherosclerotic calcification, as visualized on preoperative CT imaging is a risk factor for PCF in patients undergoing TL. 9