151751-Najiba-Chargi

168 CHAPTER 9 Table 2. Sarcopenia and arterial calcification as predictors of pharyngocutaneous fistula Value Unadjusted ORb (95% CI) P value Adjusted ORc (95% CI) P value Total arterial calcification score Cont.a 1.06 (1.01-1.11) 0.03 1.05 (1.00-1.10) 0.04 Sarcopenia No Yes Ref 1.96 (1.9-3.55) 0.03 Ref 1.86 (1.02-3.39) 0.04 Numbers in bold: significant at the level of p ≤ 0.05, a Continuous; score between 0 and 30, b Univariable regression analysis, c Multivariable regression analysis using a backward stepwise selection DISCUSSION This retrospective cohort study of patients undergoing laryngectomy for any indication shows that generalized arterial calcification is widespread in patients undergoing laryngectomy and is associated with developing a PCF. Moderate to severe arterial calcification of the descending aorta, origo of the brachiocephalic arteries and left carotid siphon were significantly asso - ciated with developing a PCF in both univariable and two multivariable regression models. A higher cumulative arterial calcification score (range 0 – 30) was significantly associated with the occurrence of PCF: the relative risk of PCF increased by 6-8% per point increase in total arterial calcification score. Our results are concurrent with recent studies in patients undergoing esophagectomy and colorectal surgery. Recent studies in patients undergoing esophagectomy showed that locoregional and generalized cardiovascular disease as identified by visual grading on preoperative imaging was a risk factor for wound healing problems and anastomotic leakage .18,19 Another study in patients undergoing colorectal surgery showed that visually graded calcification of the abdominal aorta was associated with increased morbidity after surgery. 24 It is hypothesized that both locoregional and generalized arterial vascular disease may have a detrimental effect on wound and anastomosis healing due to low flow or hypoperfusion of the surgical area, leading to ischemia. 19,25 The occurrence of a PCF after TL is one of the most severe and most dreaded complications. It is associated with prolonged hospital stay and feeding tube dependency, as well as decreased quality of life, and it negatively affects survival. Recently, radiologically assessed sarcopenia was identified as a preoperative risk factor for PCF and wound complications in head and neck cancer patients. 8,9,26 There may be a link between the presence of arterial calcifications and sarcopenia, due systemic inflammation being a shared etiological factor. The copresence of sarcopenia and arterial calcification was often observed and at the location of the descending aorta arterial calcifications were significantly more often present in patients with sarcopenia. In multivariable regression analysis, the presence of sarcopenia and arterial calcifications were both independent predictors of PCF. Routinely performed CT imaging may provide more additional information on patients’ functional and biological status and may aid in the identification of high-risk patients for the