1. Severity of oEsophageal Anastomotic Leak in patients after oesophagectomy: the SEAL score
- Author
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Koen Hartemink, Ahmet Burak Ciftci, Ewen Griffiths, Nicola Colucci, Efstratia Baili, Flavio Roberto Takeda, Alex Boddy, Alexandros Charalabopoulos, Rodica Birla, Sander Ubels, Marije Schoemaker-Zwakman, Ivan Cecconello, Camiel Rosman, Andrew Hindmarsh, Moniek Verstegen, Dimitrios K. Manatakis, Elif Colak, Neil Merrett, Bastiaan Klarenbeek, Stefan Bouwense, Mark Van Berge Henegouwen, Charles-Henri Wassmer, Surgery, CCA - Cancer Treatment and quality of life, Amsterdam Gastroenterology Endocrinology Metabolism, CCA - Cancer Treatment and Quality of Life, MUMC+: MA Heelkunde (9), and RS: FHML non-thematic output
- Subjects
INTRATHORACIC MANIFESTATIONS ,COMPLICATIONS ,Esophageal Neoplasms ,Anastomosis ,MORTALITY ,Anastomosis, Surgical ,Anastomotic Leak ,Esophagectomy, Leak, esophageal cancer ,OMENTOPLASTY ,Humans ,Logistic Models ,Retrospective Studies ,Esophagectomy ,CANCER ,30-DAY ,REINFORCEMENT ,Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10] ,Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14] ,QUALITY-OF-LIFE ,Surgical ,MANAGEMENT ,Surgery ,Leak ,esophageal cancer - 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.
- Published
- 2022
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