Preoperative CT Evaluation of Abdominal Vasculature and the Risk of Surgical Complications in Colorectal Cancer Resection with Anastomosis: A Systematic Review and Meta-Analysis

Figures

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  Figure A1. Forest plot of the association between preoperative mesenteric arterial stenosis (≥50% vs. <50%) and anastomotic leak (AL), stratified by artery (celiac axis [CA], superior mesenteric artery [SMA], inferior mesenteric artery [IMA]). These studies did not meet the CRC-specific eligibility criteria for the main synthesis unless CRC-only data were available. Results from this plot were not used for the GRADE certainty rating or for the main conclusions [17,18,19]. Squares represent individual study effects (size proportional to study weight) and diamonds represent pooled effects; horizontal lines indicate 95% CIs.

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  Figure 1. PRISMA 2020 flow diagram for this systematic review.

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  Figure 2. Forest plot showing the odds ratios (ORs) and 95% confidence intervals (CIs) of abdominal CT calcification scores for the prediction of postoperative complications. Outcomes are grouped into “Major morbidity”, “Anastomotic leak” and “Grade C anastomotic leak” and only subgroup-level aggregate statistics are reported. Squares represent individual study effects (size proportional to study weight) and diamonds represent pooled effects; horizontal lines indicate 95% CIs. No double-zero event study–outcome comparisons were excluded from the pooled calcification analyses shown; the exclusion rule was prespecified but not triggered [20,21,27,28,29,30,31,33,34,35,36,37].

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  Figure 3. Leave-one-out influence analysis for the random-effects meta-analysis of high vs. low CT calcium score and any anastomotic leak. Each row shows the pooled odds ratio and heterogeneity estimates after omitting the named study [20,21,28,29,30,31,33,34,35,36,37].

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  Figure 4. Baujat plot for the random-effects meta-analysis of AAC and any AL. The x-axis shows each study’s contribution to overall heterogeneity, and the y-axis shows its influence on the pooled effect estimate [20,21,28,29,30,31,33,34,35,36,37].

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  Figure 5. Forest plot of the subgroup meta-analysis for the association between AAC score and any AL, stratified by calcification cut point (non-ROC-derived vs. ROC-derived) [20,21,28,29,30,31,33,34,35,36,37]. Squares represent individual study effects (size proportional to study weight) and diamonds represent pooled effects; horizontal lines indicate 95% CIs.

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  Figure 6. Funnel plot for any AL. (A) Observed funnel plot. (B) Funnel plot after trim-and-fill (imputed studies shown as open points).

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  Figure 7. Examples of CT-derived vascular disease markers. (A) 3D maximum intensity projection reconstruction of the abdominal vessels showing significant calcific burden predominantly concentrated in the infrarenal abdominal aorta (red arrow) and the internal iliac arteries (blue arrows). (B) CT angiography showing stenosis of the inferior mesenteric artery (red arrow). (C) Non-contrast CT image at the L3 vertebral level showing calcifications covering the entire circumference of the inferior abdominal aorta (red arrow). (D) Same examination: the red arrow points to calcifications involving the internal iliac artery.