Background: Chyle leaks are a rare, but potentially morbid, postoperative complication. No data on incidence, management, or natural history of chyle leaks following pancreatic resection (PR) have been published. We sought to identify possible risk factors associated with chyle leaks following PR, as well as determine the natural history of this rare complication.
Methods: Between 1993-2007, 2835 patients (pts) underwent PR at a single institution. Data on demographics, operative details, primary tumor status, and - when indicated - chyle leak were collected. To identify risk factors associated with chyle leak a matched 3:1 paired analysis was used to compare pts with chyle leaks vs pts without chyle leaks.
Results: Of 2835 pts undergoing PR, 41 (1.4%) developed a chyle leak (n=31, contained chyle leak vs n=10, diffuse chylous ascites). Primary disease was adenocarcinoma (53.7%), intraductal papillary mucinous neoplasm (12.2%), neuroendocrine (12.2%), pancreatitis (7.3%), or other (14.6%). PR included pylorus preserving pancreaticoduodenectomy (PD) (70.7%), classic PD (19.5%), total pancreatectomy (7.3%), and distal pancreatectomy (2.5%). Chyle leak was identified at median 8 days following surgery (leak, 5 days vs ascites, 13 days;P<0.001). Median drain triglyceride and amylase levels were 442 ng/dL and 17.5 ng/dL, respectively. After matching on tumor size, disease etiology, and resection type, history of concomitant vascular resection predicted higher risk of chyle leak (OR=4.9;P=0.03). Increasing number of harvested lymph nodes was not associated with risk of chyle leak (P=0.18). The majority of pts (53.7%) were managed with total parenteral nutrition (TPN) (leak, 14 days vs ascites, 23 days;P=0.03). Although lymphoscintigraphy (n=4) and lymphangiogram (n=2) were utilized, site of chyle leak was identified in only 2 cases. Attempts at sclerotic therapy (n=1) and re-operation (n=1) were unsuccessful. Overall, the median time to resolution of the chyle leak was 13 days (leak, 10 days vs ascites, 38 days;P<0.001). On matched analysis, the median survival of patients with chylous leak was 32.1 months compared with 29.7 monthss for patients without a leak (P=0.79). Pts with chyle ascites (median, 21.9 months) tended to have a worse overall survival vs chyle leak (median, 38.2 months)(P=0.11).
Conclusion: Chyle leak was a rare (1.4%) complication following pancreatic resection that was associated with concomitant vascular resection. In general, chyle leaks were successfully managed with TPN with no adverse impact on outcome. Pts with chylous ascites, however, had a more protracted clinical course and tended to have a worse long-term survival.