• Simone Augustinus, Anouk E J Latenstein, Bert A Bonsing, Olivier R Busch, Bas Groot Koerkamp, de HinghIgnace H J TIHJTDepartment of Surgery, Catherina Hospital, Eindhoven, The Netherlands., Vincent E de Meijer, I Quintus Molenaar, Hjalmar C van Santvoort, Judith de Vos-Geelen, Casper H van Eijck, Marc G Besselink, and Dutch Pancreatic Cancer Group.
• Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands.
• Ann. Surg. 2023 Jun 1; 277 (6): e1299e1305e1299-e1305.

ObjectiveThe aim of this study was to assess the clinical impact and risk factors of chyle leak (CL).BackgroundIn 2017, the International Study Group for Pancreatic Surgery (ISGPS) published the consensus definition of CL. Multicenter series validating this definition are lacking and previous studies investigating risk factors have used different definitions and showed heterogeneous results.MethodsThis observational cohort study included all consecutive patients after pancreatoduodenectomy in all 19 centers in the mandatory nationwide Dutch Pancreatic Cancer Audit (2017-2019). The primary endpoint was CL (ISGPS grade B/C). Multivariable logistic regression analyses were performed.ResultsOverall, 2159 patients after pancreatoduodenectomy were included. The rate of CL was 7.0% (n=152), including 6.9% (n=150) grade B and 0.1% (n=2) grade C. CL was independently associated with a prolonged hospital stay [odds ratio (OR)=2.84, 95% confidence interval (CI): 1.85-4.36, P <0.001] but not with mortality (OR=0.3, 95% CI: 0.0-2.3, P =0.244). In multivariable analyses, independent predictors for CL were vascular resection (OR=2.1, 95% CI: 1.4-3.2, P <0.001) and open surgery (OR=3.5, 95% CI: 1.7-7.2, P =0.001). The number of resected lymph nodes and aortocaval lymph node sampling were not identified as predictors in multivariable analysis.ConclusionsIn this nationwide analysis, the rate of ISGPS grade B/C CL after pancreatoduodenectomy was 7.0%. Although CL is associated with a prolonged hospital stay, the clinical impact is relatively minor in the vast majority (>98%) of patients. Vascular resection and open surgery are predictors of CL.Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.

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