Definition and classification of chyle leak after pancreatic operation: A consensus statement by the International Study Group on Pancreatic Surgery.
Recent literature suggests that chyle leak may complicate up to 10% of pancreatic resections. Treatment depends on its severity, which may include chylous ascites. No international consensus definition or grading system of chyle leak currently is available.



The International Study Group on Pancreatic Surgery, an international panel of pancreatic surgeons working in well-known, high-volume centers, reviewed the literature and worked together to establish a consensus on the definition and classification of chyle leak after pancreatic operation.



Chyle leak was defined as output of milky-colored fluid from a drain, drain site, or wound on or after postoperative day 3, with a triglyceride content ≥110 mg/dL (≥1.2 mmol/L). Three different grades of severity were defined according to the management needed: grade A, no specific intervention other than oral dietary restrictions; grade B, prolongation of hospital stay, nasoenteral nutrition with dietary restriction, total parenteral nutrition, octreotide, maintenance of surgical drains, or placement of new percutaneous drains; and grade C, need for other more invasive in-hospital treatment, intensive care unit admission, or mortality.



This classification and grading system for chyle leak after pancreatic resection allows for comparison of outcomes between series. As with the other the International Study Group on Pancreatic Surgery consensus statements, this classification should facilitate communication and evaluation of different approaches to the prevention and treatment of this complication.
Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Electronic address: m.g.besselink@amc.nl.
Marc G
MG
Besselink
Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
L Bengt
LB
van Rijssen
Department of Surgery and Oncology, Pancreas Institute, University of Verona, Verona, Italy.
Claudio
C
Bassi
Department of First Surgery, Agia Olga Hospital, Athens, Greece.
Christos
C
Dervenis
Department of Surgery, Humanitas Research Hospital and University, Milan, Italy.
Marco
M
Montorsi
Department of HPB Surgery, Hopital Edouard Herriot, HCL, UCBL1, Lyon, France.
Mustapha
M
Adham
Department of Surgery, Mayo Clinic, Jacksonville, FL.
Horacio J
HJ
Asbun
Department of General-, Visceral-, and Thoracic-Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Maximillian
M
Bockhorn
Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
Oliver
O
Strobel
Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
Markus W
MW
Büchler
Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Olivier R
OR
Busch
Department of HPB & Transplant Surgery, Freeman Hospital, Newcastle upon Tyne, UK.
Richard M
RM
Charnley
Professorial Surgical Unit, University of Dublin, Trinity College, Dublin, Ireland.
Kevin C
KC
Conlon
Department of Surgery, Clinic Hospital of Barcelona, University of Barcelona, Barcelona, Spain.
Laureano
L
Fernández-Cruz
First Department of Digestive Surgery, Hippokrateon Hospital, University of Athens, Athens, Greece; Section for Surgical Research, Department of Surgery, Medical University of Graz, Graz, Austria.
Abe
A
Fingerhut
Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
Helmut
H
Friess
Department of General-, Visceral-, and Thoracic-Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Jakob R
JR
Izbicki
Department of Surgery, Massachusetts General Hospital and the Harvard Medical School, Boston, MA.
Keith D
KD
Lillemoe
Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK.
John P
JP
Neoptolemos
Division of Subspecialty General Surgery, Mayo Clinic, Rochester, MN.
Michael G
MG
Sarr
Department of GI and HPB Surgical Oncology, Tata Memorial Hospital, Mumbai, India.
Shailesh V
SV
Shrikhande
Department of Surgical Oncology, Medical University in Lublin, Poland.
Robert
R
Sitarz
Department of Surgery, Penn Medicine, The University of Pennsylvania, Philadelphia, PA.
Charles M
CM
Vollmer
Department of Surgery, Jefferson Pancreas, Biliary and Related Cancer Center, Thomas Jefferson University, Philadelphia, PA.
Charles J
CJ
Yeo
Division of Pancreatic Surgery, Department of General, Visceral, and Transplantation Surgery, Ludwig Maximilians University, University of Munich, Germany.
Werner
W
Hartwig
Department of Surgery, Johns Hopkins Medicine, Baltimore, MD.
Christopher L
CL
Wolfgang
Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Dirk J
DJ
Gouma
D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D057868:Anastomotic Leak / Q000145:classification* / Q000628:therapy; D002915:Chylous Ascites / Q000145:classification* / Q000209:etiology / Q000628:therapy; D032921:Consensus; D005260:Female; D006801:Humans; D038622:Internationality; D008297:Male; D010180:Pancreatectomy / Q000009:adverse effects* / Q000379:methods; D010190:Pancreatic Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000145:classification / Q000628:therapy; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome