P1.191. A Novel ICG Fluorescence-Based Risk Stratification Tool for Post-Esophagectomy Anastomotic Leak (FLARE Score)

Clicks: 18
ID: 326166
2026
Free PDF
Article Quality & Performance Metrics
Overall Quality
Not rated
Combines reader engagement with the AI quality analysis. This article has not been analysed, so there is no overall score — reader engagement is measured and shown alongside.
AI Quality Assessment
Not analyzed
Readership in this journal
Emerging

Ranked #420 of 453 articles by views in diseases of the esophagus : official journal of the international society for diseases of the esophagus

Most read Least read

Bar heights use a square-root scale. Only the 120 most-read articles are drawn; the journal has 453 in total.

Mint this article as an NFT
Not yet minted

Create a permanent, verifiable on-chain record of this article on the Scimatic Network. The NFT is held in your Journament account, and you can withdraw it to your own wallet at any time.

5 SUSD one-off · no wallet required
Sign in to mint
Abstract
Abstract Topic Esophageal Cancer: Surgical Treatment of Esophageal Cancer Background Anastomotic leak remains the most feared complication after esophagectomy, with reported rates of 5–20%. Indocyanine green (ICG) fluorescence angiography enables real-time perfusion assessment, yet no validated scoring system integrates ICG parameters with clinical risk factors. We aimed to develop and internally validate the FLARE (Fluorescence-guided Anastomotic Leak Risk Evaluation) score. Methods Ambispective analysis of 148 consecutive esophagectomy patients (January 2022–June 2025): prospective-ICG group (n=71) and retrospective non-ICG group (n=77). Primary outcome: anastomotic leak. Univariate analysis used Fisher's Exact Test/Chi-Square Test and Mann-Whitney U test. The 3-variable Clinical-EARS (Esophageal Anastomotic Leak Risk Score) was derived using OR-weighted integer assignment from statistically significant predictors: male sex (3 points), active smoking (2 points), tracheostomy (1 point); maximum 6 points. Variables with ROC-AUC below 0.60 (operative duration, blood loss) were excluded on statistical grounds. Internal validation was performed in the non-ICG cohort using bootstrap resampling (n=2000 iterations) with Hosmer-Lemeshow calibration testing and 5-fold cross-validation. The ICG-FLARE score additionally incorporated ICG perfusion peak time greater than 20 seconds (3 points) and ICG–naked eye assessment mismatch (3 points); maximum 12 points. Secondary outcomes included chyle leak. Results Anastomotic leak occurred in 7.0% (ICG) versus 15.6% (non-ICG; OR=0.41, p=0.171). ICG significantly reduced chyle leak (1.4% vs 11.7%; OR=0.11; p=0.018). Male sex (OR=10.53; p=0.006) and smoking (OR=4.74; p=0.018) were the only independent predictors on univariate analysis. Clinical-EARS stratified risk stepwise across all 148 patients: Low (0–1 pts) 2.4%, Medium (2–3 pts) 5.4%, High (4–6 pts) 20.3% (AUC=0.734; 95%CI: 0.640–0.821). Internal validation in the non-ICG cohort confirmed discrimination (AUC=0.685; 95%CI: 0.563–0.798) with minimal optimism (0.049) and excellent calibration (Hosmer-Lemeshow p=0.977). ICG-FLARE substantially improved performance in ICG patients (AUC=0.918; 95%CI: 0.802–0.998; ΔAUC=+0.159). At the optimal cutoff (≥7 points), ICG-FLARE achieved a sensitivity 80.0% and a specificity 90.9%. Perfusion peak time greater than 20 seconds (OR=14.86; p=0.013) and ICG–naked eye mismatch (OR=18.3; p=0.009) were independently predictive. Conclusion The FLARE score provides validated, clinically actionable risk stratification for anastomotic leak after esophagectomy. Clinical-EARS achieves robust discrimination (AUC=0.734) with excellent calibration and internal validation, applicable to all patients regardless of ICG availability. ICG-FLARE dramatically enhances performance (AUC=0.918; sensitivity 80%, specificity 90.9%), demonstrating that ICG fluorescence angiography delivers independent prognostic information beyond clinical factors alone. Prospective external validation is warranted.
Reference Key
openalex_W7203992335 Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors Abhijit Talukdar, Mohit Malhotra, Dibyajyoti Deka, Kunal Deka
Are you one of these authors? Claim your profile
Journal diseases of the esophagus : official journal of the international society for diseases of the esophagus
Year 2026
DOI
10.1093/dote/doag077.339
URL
https://academic.oup.com/dote/article-pdf/39/Supplement_1/doag077.339/70761288/doag077.339.pdf
Keywords Keywords not found

Citations

No citations found. To add a citation, contact the admin at info@scimatic.org

Comments

No comments yet. Be the first to comment on this article.