title: Incidence and management of chyle leaks following pancreatic resection: a high volume single-center institutional experience.
abstract: BACKGROUND
  No data on incidence, management, or natural history of chyle leaks following pancreatic resection have been published. We sought to identify possible risk factors associated with chyle leaks following pancreatic resection, as well as determine the natural history of this rare complication.
  
  
  METHODS
  Between 1993 and 2008, 3,532 patients underwent pancreatic resection at a single institution. Data on demographics, operative details, primary tumor status, and chyle leak were collected. To identify risk factors associated with chyle leak, a matched 3:1 paired analysis was performed.
  
  
  RESULTS
  Of 3,532 patients undergoing pancreatic resection, 47 (1.3%) developed a chyle leak (n = 34, contained chyle leak versus n = 13, diffuse chylous ascites). Chyle leak was identified at median 5 days following surgery. Median drain triglyceride levels were 592 ng/dl. After matching on tumor size, disease etiology, and resection type, the number of lymph nodes harvested and history of concomitant vascular resection predicted higher risk of chyle leak (both P < 0.05). Total parenteral nutrition (TPN) was required in more patients with chylous ascites (92.3%) than those with chyle leaks (44.1%) (P = 0.003). The median time to resolution was shorter for contained chyle leaks (13 days) versus chylous ascites (36 days) (P < 0.001). Patients with chylous ascites tended to have shorter overall survival (3-year, 18.8%) versus patients with no chyle leak (3-year, 46.9%) (P = 0.12). In contrast, patients with a contained chyle leak had a similar survival as patients with no chyle leak (3-year, 53.4% versus 46.9%, respectively) (P = 0.32).
  
  
  CONCLUSIONS
  Chyle leak was a rare (1.3%) complication following pancreatic resection that was associated with number of lymph nodes harvested and concomitant vascular resection. In general, chyle leaks were successfully managed with TPN with no adverse impact on outcome. Patients with chylous ascites, however, had a more protracted clinical course and tended to have a worse long-term survival.
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Lia
authors.initials: L
authors.lastname: Assumpcao
authors.forename: John L
authors.initials: JL
authors.lastname: Cameron
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Wolfgang
authors.forename: Barish
authors.initials: B
authors.lastname: Edil
authors.forename: Michael A
authors.initials: MA
authors.lastname: Choti
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Herman
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Geschwind
authors.forename: Kelvin
authors.initials: K
authors.lastname: Hong
authors.forename: Christos
authors.initials: C
authors.lastname: Georgiades
authors.forename: Richard D
authors.initials: RD
authors.lastname: Schulick
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D002913:Chyle; D002915:Chylous Ascites / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy*; D016001:Confidence Intervals; D004322:Drainage / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010180:Pancreatectomy / Q000009:adverse effects* / Q000379:methods; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D012086:Reoperation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome