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. 2022 Apr;48(4):707-717.
doi: 10.1016/j.ejso.2021.11.136. Epub 2021 Dec 3.

Incidence and risk factors for Chyle leak after pancreatic surgery for cancer: A comprehensive systematic review

Milena Muzzolini  1 , Raphael L C Araujo  2 , T Peter Kingham  3 , Frédérique Peschaud  4 , François Paye  5 , Renato M Lupinacci  6
Affiliations

Incidence and risk factors for Chyle leak after pancreatic surgery for cancer: A comprehensive systematic review

Milena Muzzolini et al. Eur J Surg Oncol. 2022 Apr.

Abstract

Background: Chyle leak (CL) is a clinically relevant complication after pancreatectomy. Its incidence and the associated risk factors are ill defined, and various treatments options have been described. There is no consensus, however, regarding optimal management. The present study aims to systematically review the literature on CL after pancreatectomy.

Methods: A systematic review from PubMed, Scopus and Embase database was performed. Studies using a clear definition for CL and published from January 2000 to January 2021 were included. The PRISMA guidelines were followed during all stages of this systematic review. The MINORS score was used to assess methodological quality.

Results: Literature search found 361 reports, 99 of which were duplicates. The titles and abstracts of 262 articles were finally screened. The references from the remaining 181 articles were manually assessed. After the exclusions, 43 articles were thoroughly assessed. A total of 23 articles were ultimately included for this review. The number of patients varied from 54 to 3532. Incidence of post pancreatectomy CL varied from 1.3% to 22.1%. Main risk factors were the extent of the surgery and early oral or enteral feeding. CL dried up spontaneously or after conservative management within 14 days in 53% to 100% of the cases.

Conclusions: The extent of surgery is the most common predictor of risk of CL. Conservative treatment has been shown to be effective in most cases and can be considered the treatment of choice. We propose a management algorithm based on the current available evidence.

Keywords: Chyle leak; Complication; Pancreas; Postoperative; Surgery.

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Conflict of interest statement

Declaration of competing interest The authors declare no conflicts of interest or financial ties related to this article.

Figures

Fig. 1.
Fig. 1.
Flow diagram of the study selection process.
Fig. 2.
Fig. 2.
Proposition of an algorithm for the diagnosis and management of CL following pancreatic surgery. After clinical resolution of CL, it could be reasonable to maintain the MCT or low fat diet for a few weeks to limit the risk of recurrence. (TG, triglyceride; CL, chyle leak; POPF, postoperative pancreatic fistula; MCT, medium-chain triglyceride; TPN, total parenteral nutrition).
See this image and copyright information in PMC

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