Severity of oEsophageal Anastomotic Leak in patients after oesophagectomy: the SEAL score
Sander Ubels, Moniek Verstegen, Bastiaan Klarenbeek, Stefan A.W. Bouwense, Mark I. van Berge Henegouwen, Freek Daams, Marc J. van Det, Ewen A. Griffiths, Jan Willem Haveman, Joos Heisterkamp, Renol Koshy, Grard A. P. Nieuwenhuijzen, Fatih Polat, Peter D. Siersema, Pritam Singh, Bas P. L. Wijnhoven, Gerjon Hannink, Frans van Workum, Camiel Rosman, the TENTACLE—Esophagus Collaborative Group, E Matthée, Cettela A.M. Slootmans, Gijs Ultee, Jeroen Schouten, Suzanne S. Gisbertz, Wietse J. Eshuis, Marianne C. Kalff, Minke L. Feenstra, Donald L. van der Peet, Wessel T. Stam, Boudewijn van Etten, Floris B. Poelmann, Nienke Vuurberg, Jan Willem van den Berg, Ingrid S. Martijnse, R M Matthijsen, Misha Luyer, Wouter L. Curvers, Tom Nieuwenhuijzen, A K E Taselaar, Ewout A. Kouwenhoven, Merel Lubbers, Meindert N. Sosef, Frederik Lecot, Tessa C. M. Geraedts, Stijn van Esser, Jan Willem T. Dekker, F. van den Wildenberg, Wendy Kelder, Merel Lubbers, Peter C. Baas, J W A de Haas, H.H. Hartgrink, Renu R. Bahadoer, Johanna W. van Sandick, Koen J. Hartemink, Xander Veenhof, Hein B.A.C. Stockmann, Burak Görgeç, Pepijn D. Weeder, Marinus J. Wiezer, Charlotte M. S. Genders, E Belt, Bjørn Blomberg, Peter van Duijvendijk, Leif Claaßen, David Reetz, Pascal Steenvoorde, W. J. B. Mastboom, Henk Jan Klein Ganseij, Annette D van Dalsen, Annalie Joldersma, Marije Zwakman, R.P. Groenendijk, Mahsa Montazeri, S Mercer, B Knight, Gijs van Boxel, R McGregor, Richard J. E. Skipworth, Cristina Frattini, Anna Bradley, Magnus Nilsson, Masaru Hayami, Bin Huang, James Bundred, Richard Evans, Peter Grimminger, Pieter C. van der Sluis, Ülker Eren, J. Saunders, Elena Theophilidou, Zubair Khanzada, Jessie A. Elliott, Jeroen E. H. Ponten, Sinéad King, John V. Reynolds, Bruno Sgromo, Khalid Akbari, Samar Shalaby
Abstract
BACKGROUND: Anastomotic leak (AL) is a common but severe complication after oesophagectomy. It is unknown how to determine the severity of AL objectively at diagnosis. Determining leak severity may guide treatment decisions and improve future research. This study aimed to identify leak-related prognostic factors for mortality, and to develop a Severity of oEsophageal Anastomotic Leak (SEAL) score. METHODS: This international, retrospective cohort study in 71 centres worldwide included patients with AL after oesophagectomy between 2011 and 2019. The primary endpoint was 90-day mortality. Leak-related prognostic factors were identified after adjusting for confounders and were included in multivariable logistic regression to develop the SEAL score. Four classes of leak severity (mild, moderate, severe, and critical) were defined based on the risk of 90-day mortality, and the score was validated internally. RESULTS: Some 1509 patients with AL were included and the 90-day mortality rate was 11.7 per cent. Twelve leak-related prognostic factors were included in the SEAL score. The score showed good calibration and discrimination (c-index 0.77, 95 per cent c.i. 0.73 to 0.81). Higher classes of leak severity graded by the SEAL score were associated with a significant increase in duration of ICU stay, healing time, Comprehensive Complication Index score, and Esophagectomy Complications Consensus Group classification. CONCLUSION: The SEAL score grades leak severity into four classes by combining 12 leak-related predictors and can be used to the assess severity of AL after oesophagectomy.