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.

Abstract

To identify the risk factors, manifestations, and clinical implications of chyle leak (CL) after pancreatic surgery, and to reappraise the International Study Group for Pancreatic Surgery (ISGPS) definition and classification of CL. The risk factors, clinical scenarios, and management of CL after pancreatic surgery remain controversial. Data from patients who underwent pancreatic surgery between January 2019 and July 2023 were retrieved from an institutional database. The risk factors, manifestations, and clinical impact of CL were analyzed. Of the 1,063 patients enrolled, 117 (11.0%) developed CL, including 33 grade A and 84 grade B. Minimally invasive approach (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 identified as independent risk factors for CL. Three hundred ninety-six patients (37.3%) presented with triglyceride (TG)-rich (≥1.2 mmol/L) drainage without a milky-colored appearance. The length of postoperative stay for patients with large-volume (≥300 mL/day), TG-rich but non-milky drainage (n=72) was significantly longer than that for patients with small-volume (<300 mL/day) (n=324, median, 19 days vs. 14 days, P<0.001), and it was comparable to that for patients with large-volume (≥300 mL/day), TG-rich, and milky drainage (n=74, median, 19 days vs. 22 days, P=0.126). Minimally invasive approach and daily maximum drainage volume were independent risk factors for CL in this cohort. Post-pancreatectomy patients with large-volume, TG-rich but non-milky drainage should be treated like clinically relevant CL.