Incidence, risk factors and clinical implications of chyle leak after pancreatic surgery

Abstract Introduction Chyle leak (CL) is an uncommon complication of pancreaticoduodenectomy (PD). Its incidence, risk factors, and effect on prognosis are not well described and optimum management remains debated. This study aims to calculate the incidence of CL, identify risk factors, consider effect on patient outcome, and propose a simple management algorithm. Method This is a retrospective review of all patients who developed CL following PD between January 2006 and April 2020. The following details were obtained from a prospectively maintained database: age, ASA grade, BMI, details of operation, tumour histology, length of stay, and mortality. Results A total of 560 patients underwent PD and 17 (3.04%) developed CL. These patients had significantly higher BMI (P < 0.01) and significantly longer operation times (P < 0.05). CL patients had a higher rate of portal vein (PV) tumour adherence, PV resection, and intra-operative blood transfusion although this was not statistically significant. Sixteen CL patients (94.1%) were managed successfully with a non-operative approach. Conclusions 3.04% of patients who underwent PD developed CL. CL was associated with higher BMI and longer operation time. CL did not affect length of stay. The vast majority of CL cases can be managed successfully with a non-operative approach.

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P-P02 Incidence and risk factors for chyle leak after pancreatic surgery: a systematic review and meta-analysis

British Journal of Surgery ◽

10.1093/bjs/znab430.226 ◽

2021 ◽

Vol 108 (Supplement_9) ◽

Author(s):

Chris Varghese ◽

Cameron Wells ◽

Shiela Lee ◽

Khaled Ammar ◽

Sanjay Pandanaboyana

Keyword(s):

Risk Factors ◽

Pancreatic Surgery ◽

Meta Analysis ◽

International Study ◽

Prognostic Nutritional Index ◽

Individual Risk ◽

Chyle Leak ◽

Nutritional Index ◽

Younger Age ◽

Individual Risk Factors

Abstract Background The incidence of, and risk factors for chyle leak, as defined by the 2017 International Study Group on Pancreatic Surgery (ISGPS), remain unknown. Methods MEDLINE, EMBASE, and Scopus were systematically searched for studies of patients undergoing pancreatectomy that reported chyle leak according to the 2017 ISGPS definition. The primary outcomes were the incidence of overall and clinically-relevant chyle leak. A random-effects pairwise meta-analysis was used to identify risk factors where possible. Results Thirty-five studies including 7083 patients were included in the meta-analysis. The weighted incidence of overall chyle leak was 6.8% (95% CI 5.6 - 8.2) and clinically-relevant chyle leak was 5.5% (95% CI 3.8 - 7.7). Pancreaticoduodenectomy, total pancreatectomy and distal pancreatectomy were associated with a CL incidence of 7.3%, 4.3%, 5.8% respectively. Fourteen individual risk factors for chyle leak were identified from included studies. Younger age, low prognostic nutritional index, para-aortic node manipulation, lymphatic involvement, and post-pancreatectomy pancreatitis were significantly associated with chyle leak, all from individual studies. Conclusions The incidence of overall chyle leak and clinically relevant chyle leak after pancreatic surgery, as defined by the 2017 ISGPS definition is 6.8% and 5.5% respectively. Several risk factors for chyle leak were identified in the present review, however, larger high-quality studies are needed to more accurately define these risks.

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