Management of refractory chyle leak after pancreatic surgery: Results from a French national survey on practices and a multicentric study on therapeutic lymphangiography.

Abstract

Chyle leak is an infrequent complication after pancreatectomy. We aimed to investigate chyle leak management practices in France and evaluate the use of lymphography as a therapeutic tool. A national survey on the diagnosis and treatment of chyle leak after pancreatectomy was sent to 25 surgeons from 25 expert French centers. Subsequently, a comparative retrospective study was conducted. Patients with refractory leaks treated by lymphography in France were screened for inclusion. Patients with refractory leaks treated exclusively with conservative treatment were included in a second group. Refractory chyle leak was defined as a chyle leak that persisted despite a medium-chain triglyceride-enriched diet by the time of the follow-up appointment. The management of chyle leaks is heterogeneous in France. Only 24% of centers (n = 6) performed lymphography. In total, 33 patients treated by lymphography (30.3% bipedal, 69.7% transnodal) and 23 patients treated conservatively between 2010 and 2023 were identified. Compared with conservative treatment alone, patients undergoing lymphography within 25 days of surgery (n = 25) had significantly fewer abdominal collections (34.6% vs 69.6%, P = .011), radiologic-identified drainage (23.1% vs 60.9%, P = .01), and readmission for recurrence (3.8% vs 26.1%, P = .041). Lymphography is safe and represents a potentially effective option to treat refractory chyle leaks within 25 days of surgery.