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<p>Accurate assessment of esophageal gap length in esophageal atresia (EA) remains challenging, particularly with regard to its role in predicting postoperative anastomotic morbidity. This study exploratorily compared intraoperative centimeter-based and preoperative vertebral body (VB)–based gap measurements with respect to their association with early postoperative complications in Gross type C EA. We retrospectively analyzed neonates with Gross type C EA who underwent primary primary repair between 2014 and 2024. Intraoperative esophageal gap length (cm) and preoperative VB-based measurements obtained from chest radiographs were recorded. Associations with postoperative complications were assessed using correlation analysis and ROC curves in an exploratory risk stratification framework. 55 patients were included. ROC analysis revealed that diagnostic performance depended on cut-off threshold. Using the conventional 2 cm threshold, sensitivity was low (29.2%) while specificity remained high (87.1%), with an overall accuracy of 61.8%. The 2 VB threshold demonstrated higher sensitivity (75.0%) but lower specificity (58.1%), with an accuracy of 65.5%. Positive predictive value (58.8%) and negative predictive value (81.0%) were similar for both exploratory thresholds. VB-based estimation demonstrated a more balanced sensitivity–specificity profile for identifying patients at risk of early postoperative complications. VB-based estimation is not intended to influence intraoperative decision-making or the choice of primary anastomosis in Gross type C esophageal atresia. Instead, it may serve as a postoperative risk stratification tool, identifying patients who may benefit from closer early surveillance for anastomotic morbidity.</p>

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Which Measurement is Better Correlated with Postoperative Complication in Esophageal Atresia? Vertebral Body Count Versus Centimeter-based Gap Classification

  • 期刊论文

  • 发表日期：

    2026年4月11日

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  • İncinur Genişol,
  • Yusuf Kenan Çetinoğlu,
  • Hande Şenol,
  • Asya Eylem Boztas,
  • Arzu Sencan

摘要

Accurate assessment of esophageal gap length in esophageal atresia (EA) remains challenging, particularly with regard to its role in predicting postoperative anastomotic morbidity. This study exploratorily compared intraoperative centimeter-based and preoperative vertebral body (VB)–based gap measurements with respect to their association with early postoperative complications in Gross type C EA. We retrospectively analyzed neonates with Gross type C EA who underwent primary primary repair between 2014 and 2024. Intraoperative esophageal gap length (cm) and preoperative VB-based measurements obtained from chest radiographs were recorded. Associations with postoperative complications were assessed using correlation analysis and ROC curves in an exploratory risk stratification framework. 55 patients were included. ROC analysis revealed that diagnostic performance depended on cut-off threshold. Using the conventional 2 cm threshold, sensitivity was low (29.2%) while specificity remained high (87.1%), with an overall accuracy of 61.8%. The 2 VB threshold demonstrated higher sensitivity (75.0%) but lower specificity (58.1%), with an accuracy of 65.5%. Positive predictive value (58.8%) and negative predictive value (81.0%) were similar for both exploratory thresholds. VB-based estimation demonstrated a more balanced sensitivity–specificity profile for identifying patients at risk of early postoperative complications. VB-based estimation is not intended to influence intraoperative decision-making or the choice of primary anastomosis in Gross type C esophageal atresia. Instead, it may serve as a postoperative risk stratification tool, identifying patients who may benefit from closer early surveillance for anastomotic morbidity.