• Sheraz Markar, Caroline Gronnier, Alain Duhamel, Jean-Yves Mabrut, Jean-Pierre Bail, Nicolas Carrere, Jérémie H Lefevre, Cécile Brigand, Jean-Christophe Vaillant, Mustapha Adham, Simon Msika, Nicolas Demartines, Issam El Nakadi, Bernard Meunier, Denis Collet, Christophe Mariette, and FREGAT (French Eso-Gastric Tumors) working group, FRENCH (Fédération de Recherche EN CHirurgie), and AFC (Association Française de Chirurgie).
• *Department of Surgery and Cancer, Imperial College, London, UK †Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France ‡North of France University, Lille, France §Inserm, UMR837, Team 5 "Mucins, Epithelial Differentiation and Carcinogenesis," JPARC, Lille, France ¶SIRIC OncoLille, Lille, France ||Department of Biostatistics, University Hospital, Lille, France **Departments of Digestive Surgery of Croix-Rousse University Hospital, Lyon, France ††Cavale Blanche University Hospital, Brest, France ‡‡Purpan University Hospital, Toulouse, France §§Saint Antoine University Hospital, Paris, France ¶¶Hautepierre University Hospital, Strasbourg, France ||||Pitié-Salpétrière University Hospital, Paris, France ***Edouard Herriot University Hospital, Lyon, France †††Louis Mourier University Hospital, Colombes, France ‡‡‡Vaudois University Hospital, Lausanne, Switzerland §§§ULB-Erasme-Bordet University Hospital, Bruxelles, Belgium ¶¶¶Pontchaillou University Hospital, Rennes, France ||||||Haut-Levêque University Hospital, Bordeaux, France.
• Ann. Surg. 2015 Dec 1;262(6):972-80.

ObjectiveThe aim of this study was to the determine impact of severe esophageal anastomotic leak (SEAL) upon long-term survival and locoregional cancer recurrence.BackgroundThe impact of SEAL upon long-term survival after esophageal resection remains inconclusive with a number of studies demonstrating conflicting results.MethodsA multicenter database for the surgical treatment of esophageal cancer collected data from 30 university hospitals (2000-2010). SEAL was defined as a Clavien-Dindo III or IV leak. Patients with SEAL were compared with those without in terms of demographics, tumor characteristics, surgical technique, morbidity, survival, and recurrence.ResultsFrom a database of 2944 operated on for esophageal cancer between 2000 and 2010, 209 patients who died within 90 days of surgery and 296 patients with a R1/R2 resection were excluded, leaving 2439 included in the final analysis; 208 (8.5%) developed a SEAL and significant independent association was observed with low hospital procedural volume, cervical anastomosis, tumoral stage III/IV, and pulmonary and cardiovascular complications. SEAL was associated with a significant reduction in median overall (35.8 vs 54.8 months; P = 0.002) and disease-free (34 vs 47.9 months; P = 0.005) survivals. After adjustment of confounding factors, SEAL was associated with a 28% greater likelihood of death [hazard ratio = 1.28; 95% confidence interval (CI): 1.04-1.59; P = 0.022], as well as greater overall (OR = 1.35; 95% CI: 1.15-1.73; P = 0.011), locoregional (OR = 1.56; 95% CI: 1.05-2.24; P = 0.030), and mixed (OR = 1.81; 95% CI: 1.20-2.71; P = 0.014) recurrences.ConclusionsThis large multicenter study provides strong evidence that SEAL adversely impacts cancer prognosis. The mechanism through which SEAL increases local recurrence is an important area for future research.

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