title: Drainage volume after pancreaticoduodenectomy is a warning sign of chyle leakage that inversely correlates with a diagnosis of pancreatic fistula.
abstract: BACKGROUND
  Chyle leakage is a rare complication of pancreaticoduodenectomy (PD), and its association with pancreatic fistula has not been established. The aim of this study was to (1) evaluate the incidence, management, and risk factors of chyle leakage after PD; (2) determine if there is a relation between chyle leakage and diagnosis of pancreatic fistula; and (3) predict chyle leakage with drainage volume early.
  
  
  METHODS
  A total of 222 patients underwent PD or pylorus-preserving PD. We used the clinical database registry system of the Gangnam Severance Hospital, Yonsei University Health System to establish a retrospective cohort with clinicopathologic data.
  
  
  RESULTS
  Altogether, 24 patients (10.8 %) developed chyle leakage. Chyle leakage was identified at a median 5 days after surgery and a mean 2 days after enteral intake. The mean drain triglyceride level was 315 mg/dl. Early enteral intake was independently associated with chyle leakage. Chyle leakage was inversely correlated with a diagnosis of pancreatic fistula with marginal significance (odds ratio 0.27; 95 % confidence interval 0.66-1.09). The receiver operating characteristic curve of the volume on postoperative day 4 demonstrated an area under the curve of 0.740 (p = 0.0001). Drainage >335 ml indicated possible chyle leakage.
  
  
  CONCLUSIONS
  Chyle leakage after PD is associated with early enteral intake. It was inversely correlated with a diagnosis of pancreatic fistula because of the dilution effect of drainage volume on the concentration of drained amylase. Because early diagnosis helps with appropriate management, prediction/suspicion of chyle leakage based on drainage volume may be useful.
authors: Pancreatobiliary Cancer Clinic, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eunjoro Gangnam-gu, Seoul, 135-720, South Korea.
authors: Jae Keun
authors: JK
authors: Kim
authors: Joon Seong
authors: JS
authors: Park
authors: Ho Kyoung
authors: HK
authors: Hwang
authors: Hyun Wook
authors: HW
authors: Shin
authors: Dong Sup
authors: DS
authors: Yoon
mesh_terms: D000368:Aged; D002913:Chyle; D015331:Cohort Studies; D004322:Drainage; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010185:Pancreatic Fistula / Q000175:diagnosis* / Q000209:etiology; D016577:Pancreaticoduodenectomy; D011182:Postoperative Care; D011183:Postoperative Complications / Q000175:diagnosis*; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors
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