Severity of oEsophageal Anastomotic Leak in patients after oesophagectomy: the SEAL score

作者：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, Christian A. Gutschow, Henner Schmidt, Diana Vetter, K Moorthy, M A H Ibrahim, Gregory Christodoulidis, Jari Räsänen, Juha Kauppi, Henna Söderström, Dimitrios K. Manatakis, Dimitrios P. Korkolis, D Balalis, Aliki Rompu, Bilal Alkhaffaf, Mohamed Alasmar, Moaad Arebi, Guillaume Piessen, Frederiek Nuytens, Sébastien Degisors, Ali Ahmed, Alex Boddy, Sanjiv K. Gandhi, Oluwatomini Fashina, Elke Van Daele, Piet Pattyn, William B. Robb, Mayilone Arumugasamy, Mohammed Al Azzawi, Jack Whooley, Elif Çolak, Engin Aybar, Ahmet C. Sari, Mustafa Safa Uyanık, Ahmet Burak Çiftçi, Raza Sayyed, Bushra Ayub, Ghulam Murtaza, A.I. Saeed, Priyanka Ramesh, Alexandros Charalabopoulos, Theodore Liakakos, Dimitriοs Schizas, Efstratia Baili, Alkistis Kapelouzou, Michele Valmasoni, Elisa Sefora Pierobon, Giovanni Capovilla, Stefano Merigliano, Constantinoiu Silviu, B Rodica, Alexandra Florin, R Cristian Gelu, H Petre, R Guevara Castro, Andrés Felipe Salcedo, Ionuţ Negoi, Valentina Madalina Negoita, Cezar Ciubotaru, Bogdan Stoica, Sorin Hostiuc, Nicola Colucci, Stefan Mönig, Charles‐Henri Wassmer, Jérémy Meyer, Flávio Roberto Takeda, Rubens Antônio Aissar Sallum, Ulysses Ribeiro, Ivan Cecconello, Enrique Toledo, Maria Soledad Trugeda, Marta Jiménez Fernández, Cristina Gil, Sonia Castanedo, A Isik, Eray Kurnaz, José Flávio Videira, Mariana Peyroteo, Rita Canotilho, Jacopo Weindelmayer, Simone Giacopuzzi, Carlo Alberto De Pasqual, M. Bruna, Fernando Mingol, Javier Vaqué, Carla Pérez, Alexander W. Phillips, Jakub Chmelo, Joshua Brown, Laura Han, James Gossage, Andrew Davies, Cara Baker, Mark Kelly, M. Saad, Daniele Bernardi, Luigi Bonavina, Emanuele Asti, Claudio Riva, Rosa Scaramuzzo, Muhammed Elhadi, Hazem Ahmed, Muhammed Elhadi, F.A. Elnagar, Ahmed Msherghi, Vanessa Wills, Cassidy Campbell, Marisol Perez Cerdeira, Scott D. Whiting, Neil D. Merrett, A. Das, Christos Apostolou, Armando J. Lorenzo, Filipa Sousa, José Barbosa, Vítor Devezas, Elisabete Barbosa, Carlos Fernandes, Garett Smith, E Y Li, Nazim Bhimani, Priscilla H. Chan, Krishna Kotecha, Michael W. Hii, Susan Ward, Mary Ann Johnson, Matthew Read, Lynn Chong, Michael Hollands, Matthew Allaway, A. J. Richardson, EL Johnston, Andy Chen, Harsh Kanhere, Shalvin Prasad, Patrick McQuillan, T. Surman, Markus Trochsler, W A Schofield, Safia K. Ahmed, Jessica L. Reid, M C Harris, Sivakumar Gananadha, J. Farrant, Nélson Rodrigues, James Fergusson, Andrew Hindmarsh, Zeeshan Afzal, Peter Safranek, Vijay Sujendran, Siobhán Rooney, Carlos Loureiro, Saioa Leturio Fernández, Ismael Díez del Val, Shameen Jaunoo, Lauren Kennedy, Ahmad Hussain, D Theodorou, Tania Triantafyllou, Charalampos Theodoropoulos, Theodora Palyvou, Muhammed Elhadi, Fatima Abdullah Ben Taher, Mustafa Ekheel, Ahmed Msherghi · 发表于：British journal of surgery · 年份：2022 · DOI：10.1093/bjs/znac226 · 被引用次数：26 · 研究领域：Esophageal Cancer Research and Treatment、Esophageal and GI Pathology、Pleural and Pulmonary Diseases

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...