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Background: In the current literature different diagnosis and treatment strategies for chyle leak after pancreatic surgery are described. In 2017, the International Study Group for Pancreatic Surgery defined a consensus-based definition for diagnosis. However, consensus on the optimal treatment strategy is lacking. Aim: The aim of this multicenter study is to investigate the current treatment and diagnosis of chyle leak after pancreatic surgery in clinical practice in the Netherlands to gain insight into practical applications of chyle leak. Methods: A nationwide survey about the diagnosis and treatment of chyle leak was sent to specialized dieticians and pancreatic surgeons from all 16 pancreatic centers collaborating in the Dutch Pancreatic Cancer Group. Data was quantitative processed according to thematic content analysis and by using descriptive analysis. Results: In total, 16 dieticians from 16 centers and 20 surgeons from 12 centers completed the questionnaire. Analysis showed that the International Study Group for Pancreatic Surgery-definition for chyle leak was used in clinical practice by 31% (n=11) of the respondents. The results show also large nationwide variation in treatment of chyle leak after pancreatic surgery, as well between as within centers. The most common treatment was a step-up approach of nutritional therapies (44% (n=16)), which starts with an enteral fat restricted diet enriched with medium chain fatty acids followed by total parenteral nutrition. Conclusion This study shows that the current diagnosis and treatment strategies for chyle leak after pancreatic surgery in clinical practice on a nationwide scale are different. More comparable studies are needed to define the optimal treatment strategy for chyle leak. There is need for an international multidisciplinary (sub)working group to reach consensus on the treatment strategy of chyle leak and to discuss implementation strategies for clinical practice.

Due to inadequate dietary intake and altered digestion and absorption of nutrients, patients after gastroesophageal cancer surgery are at high risk of becoming malnourished and to develop deficiencies in micronutrients. The goal of this study was to determine the prevalence of specific micronutrient deficiencies during follow-up. This single center prospective study included patients who underwent resection for esophageal or gastric cancer and were still alive at follow-up between January 2016 and December 2017. All patients in this study were guided by a dietician and dietary supplements or tube feeding was prescribed in case of inadequate dietary intake. Blood samples were examined for possible deficiencies in calcium, ferritin, folic acid, vitamin A, vitamin B1, vitamin B6, vitamin B12, vitamin D, vitamin E, and zinc. Primary endpoint of this study was the prevalence of specific micronutrient deficiencies. 149 patients after esophagectomy and 32 after gastrectomy were included. After esophagectomy early postoperative deficiencies (<12 months after surgery, measurements performed in 68 patients) and late postoperative deficiencies (≥12 months after surgery, measurements performed in 81 patients) were seen in vitamin D (35.8% and 25.0%) and zinc (22.6% and 16.7%). After gastrectomy vitamin D (47.4%), zinc (29.4%), vitamin B1 (15.8%) and ferritin (15.8%) were found to be deficient <12 months after surgery (measurements performed in 19 patients). Vitamin D (46.2%), zinc (16.7%), vitamin A (15.4%), and ferritin (15.4%) were deficient in the late postoperative period (measurements performed in 13 patients). This single center prospective study showed that, despite active nutritional guidance, deficiencies in vitamin D, vitamin B1, vitamin A, zinc, and ferritin are prevalent following gastroesophageal resection for cancer and should therefore be routinely checked during follow-up and prophylactic supplementation to prevent deficiencies is indicated.