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The following is a summary of “Risk Factors, Manifestations, and Implications of Chyle Leak –Following Pancreatic Surgery: The Volume May Outweigh the Milky Appearance of the Drainage in a Chyle Leak,” published in the December 2024 issue of Surgery by Li et al.
Chyle leak (CL) after pancreatic surgery presents various risk factors and management challenges, with clinical outcomes remaining controversial.
Researchers conducted a retrospective study to identify CL’s risk factors, manifestations, and clinical implications after pancreatic surgery and to reappraise the International Study Group for Pancreatic Surgery (ISGPS) definition and classification of CL.
They analyzed data from patients who underwent pancreatic surgery (January 2019 and July 2023) to assess risk factors, manifestations, and clinical impact of CL.
The results showed 1,063 patients, 117 developed CL, 33 grade A, and 84 grade B; P<0.001. minimally invasive surgery (OR: 3.087, 95% CI: 1.790-5.236, P<0.001) and maximum daily drainage volume (OR: 1.004, 95% CI: 1.003-1.005, P<0.001) were independent risk factors for CL. Additionally, 396 patients (37.3%) had triglyceride-rich (≥1.2 millimoles per liter [mmol/L]) drainage without a milky appearance. The postoperative stay for patients with large-volume (≥300 milliliters per day [mL/day]), triglyceride-rich but non-milky drainage (n=72) was significantly longer (median 19 days) compared to those with small-volume (<300 mL/day) drainage (n=324, median 14 days, P<0.001), similar to those with large-volume, triglyceride-rich, and milky drainage (n=74, median 19 days vs. 22 days, P=0.126).
They concluded that minimally invasive surgery and maximum daily drainage volume were independent risk factors for CL after pancreatic surgery, and large-volume, triglyceride-rich but non-milky drainage should be managed as clinically relevant CL.
