ArticleThe British journal of surgery2022
Severity of oEsophageal Anastomotic Leak in patients after oesophagectomy: the SEAL score.
Article in The British journal of surgery, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
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Who cites it
15 citing papers in PubMed, 1 synthesis or guideline pooled it, 21 citations in OpenAlex.
- Management of anastomotic leak after elective anterior resection for rectal cancer: A systematic review and pooled analysis.Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland · 2025Pooled it
- Infection-targeted innovations in anastomotic leak management: endoscopic advances, antimicrobial biomaterials, and precision strategies.Annals of medicine · 2026Review
- Development and internal validation of a prediction model for early anastomotic leak after minimally invasive esophagectomy: a prospective cohort study.Annals of medicine · 2026Article
- Ultra-early postoperative endoscopy reduces anastomotic leak after minimally invasive esophagectomy: a propensity score-matched study.Surgical endoscopy · 2026Article
- Cervical Anastomotic Leakage After Minimally Invasive McKeown Esophagectomy in the SAFER Surgical System: Clinical Course and Predictors of Delayed Healing.Thoracic cancer · 2026Article
- Anastomotic leak after esophagectomy for cancer in enhanced recovery protocol versus conventional care: clinical characteristics and outcomes.Frontiers in oncology · 2026Article
- Construction and validation of a machine learning model for predicting anastomotic leak following radical esophagectomy for esophageal cancer.Frontiers in oncology · 2026Article
- Stenting Versus Endoscopic Vacuum Therapy for Anastomotic Leakage After Esophago-Gastric Surgery.Journal of clinical medicine · 2025Article
- TreatmENT of AnastomotiC LeakagE after colon cancer resection: the TENTACLE - Colon study.BMC surgery · 2025Article
- Treatment of anastomotic leakage following Ivor Lewis esophagectomy-10 year experience from a Nordic center.Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus · 2024Article
- Nationwide Association of Surgical Performance of Minimally Invasive Esophagectomy With Patient Outcomes.JAMA network open · 2024Article
- Systemic Inflammatory Response and the Noble and Underwood (NUn) Score as Early Predictors of Anastomotic Leakage after Esophageal Reconstructive Surgery.Journal of clinical medicine · 2024Article
- Endoscopic Vacuum Therapy of Upper Gastrointestinal Anastomotic Leaks: How to Deal with the Challenges (with Video).Life (Basel, Switzerland) · 2023Review
- Treatment of anastomotic leak after oesophagectomy for oesophageal cancer: large, collaborative, observational TENTACLE cohort study.The British journal of surgery · 2023Observational
- Predicting mortality in patients with anastomotic leak after esophagectomy: development of a prediction model using data from the TENTACLE-Esophagus study.Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus · 2023Article
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Authors and funding
20 authors at 12 institutions in 3 countries.
Funding
Abstract
backgroundAnastomotic 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.
methodsThis 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.
resultsSome 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.
conclusionThe 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.
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