Computed tomographic angiography measured right gastroepiploic artery length and anastomotic leakage after McKeown esophagectomy: A retrospective cohort study

doi:10.4240/wjgs.v18.i4.118003

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World Journal of Gastrointestinal Surgery

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Retrospective Cohort Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Surg. Apr 27, 2026; 18(4): 118003
Published online Apr 27, 2026. doi: 10.4240/wjgs.v18.i4.118003

Computed tomographic angiography measured right gastroepiploic artery length and anastomotic leakage after McKeown esophagectomy: A retrospective cohort study

Babou Sowe, Ping Lei, Guo-Xu Tang, Feng-Jing Yang, Si-Hua Wang, Tong Song

Babou Sowe, Guo-Xu Tang, Feng-Jing Yang, Si-Hua Wang, Tong Song, Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China

Ping Lei, Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China

Co-first authors: Babou Sowe and Ping Lei.

Co-corresponding authors: Si-Hua Wang and Tong Song.

Author contributions: Sowe B and Lei P handled software measurements, designed figures and tables, and prepared the final revised version of the figures and manuscript, they contributed equally to this article, they are the co-first authors of this manuscript; Sowe B, Lei P, Tang GX, and Tong S conducted data curation and formal data analysis; Sowe B, Lei P, Wang SH, and Tong S drafted the work and critically revised it for important content; Tong S and Wang SH oversaw supervision and project administration they contributed equally to this article, they are the co-corresponding authors of this manuscript; Sowe B, Lei P, Tang GX, Yang FJ, Wang SH, and Tong S conceptualized and designed the research study, performed the investigation, and completed resource acquisition; and all authors have read and approved the final manuscript.

Institutional review board statement: This study was approved by the Medical Ethics Committee of the Institutional Review Board of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, approval No. 2025 (0895).

Informed consent statement: The informed consent was waived by the Institutional Review Board.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: The corresponding author will provide the datasets generated during this study upon reasonable request to the editor, in accordance with institutional data sharing policies.

Corresponding author: Si-Hua Wang, Consultant, Full Professor, Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan 430022, Hubei Province, China. sihua_wang@hust.edu.cn

Received: December 22, 2025
Revised: January 16, 2026
Accepted: February 24, 2026
Published online: April 27, 2026
Processing time: 124 Days and 17.5 Hours

Abstract

BACKGROUND

Anastomotic leakage (AL) is a serious complication following McKeown esophagectomy (MKE), associated with increased postoperative morbidity and mortality. The right gastroepiploic artery (RGEA) is the principal blood supply to the gastric conduit, yet its role in AL risk remains incompletely defined. This study aimed to evaluate the relationship between preoperative computed tomographic angiography (CTA) measured RGEA length and the incidence of AL following MKE while exploring whether RGEA length thresholds within our cohort could serve as risk-enrichment markers to support preoperative planning.

AIM

To evaluate the association between preoperative CTA-measured RGEA length and AL after MKE.

METHODS

A total of 679 patients who underwent MKE for esophageal cancer were included and stratified into two groups based on the presence or absence of AL (AL and Non-AL). The primary endpoint was to assess the association between AL incidence and the length of the RGEA as measured by CTA. Statistical analyses were performed using EmpowerStats and R software version 4.5.1.

RESULTS

Among the 679 patients, 109 (16.10%) developed AL. Patients in the AL group had significantly shorter RGEA lengths compared with the non-AL group (P < 0.001). Segmented regression analysis identified a cohort-specific threshold of 27.8 cm, below which the risk of AL increased. These findings suggest that shorter RGEA length is associated with elevated AL risk.

CONCLUSION

Shorter preoperative CTA-measured RGEA length is associated with a higher risk of AL. This cohort-specific threshold may serve as a risk-enrichment marker to inform perioperative planning and patient counseling.

Keywords: Esophageal cancer; McKeown esophagectomy; Computed tomographic angiography; Right gastroepiploic artery; Anastomotic leakage

Core Tip: Anastomotic leakage is a serious complication following McKeown esophagectomy. In this single-center retrospective cohort study, shorter right gastroepiploic artery length measured by preoperative computed tomographic angiography was associated with a higher incidence of anastomotic leakage. A cohort-specific threshold was identified, suggesting that preoperative assessment of vascular anatomy may assist in perioperative risk stratification. These findings provide confirmatory evidence supporting the role of quantitative preoperative anatomical evaluation, while underscoring the need for prospective validation before routine clinical implementation.