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.

中文翻译：

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食管切除术后患者食管吻合口漏的严重程度：SEAL 评分

摘要 背景吻合口瘘（AL）是食管切除术后常见但严重的并发症。目前尚不清楚如何在诊断时客观地确定 AL 的严重程度。确定泄漏严重程度可以指导治疗决策并改进未来的研究。本研究旨在确定与食管吻合口漏相关的死亡率预后因素，并制定食管吻合口漏严重程度 (SEAL) 评分。 方法这项国际回顾性队列研究在全球 71 个中心开展，纳入了 2011 年至 2019 年食管切除术后 AL 患者。主要终点是 90 天死亡率。调整混杂因素后，确定了与泄漏相关的预后因素，并将其纳入多变量逻辑回归中以制定 SEAL 评分。根据 90 天死亡率的风险定义了四级泄漏严重程度（轻度、中度、重度和危急），并且评分经过内部验证。 结果大约有 1509 名 AL 患者被纳入其中，90 天死亡率为 11.7%。SEAL 评分中包含 12 个与渗漏相关的预后因素。该分数显示出良好的校准和区分度（c 指数 0.77，95% CI 0.73 至 0.81）。根据 SEAL 评分对漏气严重程度进行分级的较高等级与 ICU 停留时间、愈合时间、综合并发症指数评分和食管切除术并发症共识组分类的显着增加相关。 结论SEAL 评分通过结合 12 个漏气相关预测因子将漏气严重程度分为四级，可用于评估食管切除术后 AL 的严重程度。