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. 2025 Oct;32(10):787-800.
doi: 10.1002/jhbp.12191. Epub 2025 Aug 13.

Comprehensive Analysis of Chyle Leak in Resected Pancreatic Head Cancer: Impact on Clinical, Oncologic, and Nutritional Outcomes

Jae Seung Kwak  1   2 , Chang Moo Kang  1   2 , Ho Kyoung Hwang  1   2 , Sung Hyun Kim  1   2 , Seung Soo Hong  1   2
Affiliations

Comprehensive Analysis of Chyle Leak in Resected Pancreatic Head Cancer: Impact on Clinical, Oncologic, and Nutritional Outcomes

Jae Seung Kwak et al. J Hepatobiliary Pancreat Sci. 2025 Oct.

Abstract

Background: Chyle leak (CL) is a relevant complication of pancreatic surgery, but its incidence, risk factors, clinical and oncologic impacts, and nutritional relevance remain inconsistent and limited.

Methods: We retrospectively reviewed patients who underwent pancreaticoduodenectomy for pancreatic head cancer from 2007 to 2023 at a single institution. The clinical impact of CL was evaluated by prolonged hospital stays and immune-nutritional status, assessed using the Controlling Nutritional Status (CONUT) score at discharge. Oncologic impact included the administration of adjuvant chemotherapy, the surgery-to-chemotherapy interval, overall survival (OS), and recurrence-free survival (RFS). Predictors of CL were identified through multivariate analyses.

Results: CL occurred in 70 patients (13.8%) and was significantly associated with prolonged hospital stay (OR: 1.947, p = 0.045) and poor CONUT score at discharge (> 6; OR: 1.820, p = 0.036). CL did not significantly impact oncologic outcomes, including adjuvant chemotherapy (p = 0.732), surgery-to-chemotherapy interval (p = 0.235), 5-year OS (p = 0.978), or 5-year RFS (p = 0.919). Independent predictors of CL included hypertension, lymph node metastasis, delayed gastric emptying, minimally invasive surgery (MIS), and operative time.

Conclusions: CL is associated with prolonged hospital stay and poor nutritional status at discharge, but shows no significant impact on long-term oncologic outcomes.

Keywords: chyle; nutritional status; pancreatic cancer; pancreaticoduodenectomy; postoperative complications.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Kaplan–Meier survival analyses were performed to compare overall survival (OS) and recurrence‐free survival (RFS) rates based on two factors: Chyle leak versus no chyle leak and pre‐discharge CONUT score > 6 versus pre‐discharge CONUT score ≤ 6. (A) The 5‐year OS rate was 65.8% in the chyle leak group and 38.1% in the no chyle leak group (p = 0.978). (B) The 5‐year RFS rate was 36.1% in the chyle leak group and 23.3% in the no chyle leak group (p = 0.919). (C) The 5‐year OS rate was significantly lower in patients with a pre‐discharge CONUT score > 6 (29.8%) compared to those with a CONUT score ≤ 6 (46.4%) (p = 0.009). (D) The 5‐year RFS rate was 15.0% in patients with a CONUT score > 6 and 30.5% in those with a CONUT score ≤ 6, with no statistically significant difference between the groups (p = 0.118).
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