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

TENTACLE—Esophagus Collaborative Group; Sander Ubels; Moniek Verstegen; Bastiaan Klarenbeek; Stefan Bouwense; Mark van Berge Henegouwen; Freek Daams; Marc J van Det; Ewen A Griffiths; Jan W Haveman; Joos Heisterkamp; Renol Koshy; Grard Nieuwenhuijzen; Fatih Polat; Peter D Siersema; Pritam Singh; Bas P.L. Wijnhoven; Gerjon Hannink; Frans van Workum; Camiel Rosman

doi:10.1093/bjs/znac226

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

TENTACLE—Esophagus Collaborative Group , Sander Ubels^*, Moniek Verstegen, Bastiaan Klarenbeek, Stefan Bouwense, Mark van Berge Henegouwen, Freek Daams, Marc J van Det, Ewen A Griffiths, Jan W Haveman, Joos Heisterkamp, Renol Koshy, Grard Nieuwenhuijzen, Fatih Polat, Peter D Siersema, Pritam Singh, Bas P.L. Wijnhoven, Gerjon Hannink, Frans van Workum, Camiel Rosman

^*Corresponding author for this work

Surgery

Research output: Contribution to journal › Article › Academic › peer-review

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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.

Original language	English
Pages (from-to)	864-871
Number of pages	8
Journal	The British journal of surgery
Volume	109
Issue number	9
Early online date	27 Jun 2022
DOIs	https://doi.org/10.1093/bjs/znac226
Publication status	Published - 1 Sept 2022

Bibliographical note

Funding Information:
The TENTACLE—Esophagus study received funding from Medtronic. The study was performed independently, and Medtronic had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript. Acknowledgements

Publisher Copyright:
© 2022 The Author(s). Published by Oxford University Press on behalf of BJS Society Ltd.

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Severity of oEsophageal Anastomotic Leak in patients after oesophagectomyFinal published version, 1.05 MBLicence: CC BY-NC

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TENTACLE—Esophagus Collaborative Group , Ubels, S., Verstegen, M., Klarenbeek, B., Bouwense, S., van Berge Henegouwen, M., Daams, F., van Det, M. J., Griffiths, E. A., Haveman, J. W., Heisterkamp, J., Koshy, R., Nieuwenhuijzen, G., Polat, F., Siersema, P. D., Singh, P., Wijnhoven, B. P. L., Hannink, G., van Workum, F., & Rosman, C. (2022). Severity of oEsophageal Anastomotic Leak in patients after oesophagectomy: the SEAL score. The British journal of surgery, 109(9), 864-871. https://doi.org/10.1093/bjs/znac226

@article{02fd7d62ef5f4a35b19ea1b5be5947ba,

title = "Severity of oEsophageal Anastomotic Leak in patients after oesophagectomy: the SEAL score",

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.",

author = "\{TENTACLE—Esophagus Collaborative Group\} and Sander Ubels and Moniek Verstegen and Bastiaan Klarenbeek and Stefan Bouwense and \{van Berge Henegouwen\}, Mark and Freek Daams and \{van Det\}, \{Marc J\} and Griffiths, \{Ewen A\} and Haveman, \{Jan W\} and Joos Heisterkamp and Renol Koshy and Grard Nieuwenhuijzen and Fatih Polat and Siersema, \{Peter D\} and Pritam Singh and Wijnhoven, \{Bas P.L.\} and Gerjon Hannink and \{van Workum\}, Frans and Camiel Rosman",

note = "Funding Information: The TENTACLE—Esophagus study received funding from Medtronic. The study was performed independently, and Medtronic had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript. Acknowledgements Publisher Copyright: {\textcopyright} 2022 The Author(s). Published by Oxford University Press on behalf of BJS Society Ltd.",

year = "2022",

month = sep,

day = "1",

doi = "10.1093/bjs/znac226",

language = "English",

volume = "109",

pages = "864--871",

journal = "The British journal of surgery",

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TENTACLE—Esophagus Collaborative Group , Ubels, S, Verstegen, M, Klarenbeek, B, Bouwense, S, van Berge Henegouwen, M, Daams, F, van Det, MJ, Griffiths, EA, Haveman, JW, Heisterkamp, J, Koshy, R, Nieuwenhuijzen, G, Polat, F, Siersema, PD, Singh, P, Wijnhoven, BPL, Hannink, G, van Workum, F & Rosman, C 2022, 'Severity of oEsophageal Anastomotic Leak in patients after oesophagectomy: the SEAL score', The British journal of surgery, vol. 109, no. 9, pp. 864-871. https://doi.org/10.1093/bjs/znac226

TY - JOUR

T1 - Severity of oEsophageal Anastomotic Leak in patients after oesophagectomy

T2 - the SEAL score

AU - TENTACLE—Esophagus Collaborative Group

AU - Ubels, Sander

AU - Verstegen, Moniek

AU - Klarenbeek, Bastiaan

AU - Bouwense, Stefan

AU - van Berge Henegouwen, Mark

AU - Daams, Freek

AU - van Det, Marc J

AU - Griffiths, Ewen A

AU - Haveman, Jan W

AU - Heisterkamp, Joos

AU - Koshy, Renol

AU - Nieuwenhuijzen, Grard

AU - Polat, Fatih

AU - Siersema, Peter D

AU - Singh, Pritam

AU - Wijnhoven, Bas P.L.

AU - Hannink, Gerjon

AU - van Workum, Frans

AU - Rosman, Camiel

N1 - Funding Information: The TENTACLE—Esophagus study received funding from Medtronic. The study was performed independently, and Medtronic had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript. Acknowledgements Publisher Copyright: © 2022 The Author(s). Published by Oxford University Press on behalf of BJS Society Ltd.

PY - 2022/9/1

Y1 - 2022/9/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85136908883&partnerID=8YFLogxK

U2 - 10.1093/bjs/znac226

DO - 10.1093/bjs/znac226

M3 - Article

C2 - 35759409

AN - SCOPUS:85136908883

SN - 0007-1323

VL - 109

SP - 864

EP - 871

JO - The British journal of surgery

JF - The British journal of surgery

IS - 9

ER -

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

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