Definition and classification of chyle leak after pancreatic operation: A consensus statement by the International Study Group on Pancreatic Surgery

Besselink, Marc G.; Rijssen, L.B. van; Bassi, Claudio; Dervenis, Christos; Montorsi, Marco; Adham, Mustapha; Asbun, Horacio J.; Bockhorn, Maximillian; Strobel, Oliver; Büchler, Markus W.; Busch, Olivier R.; Charnley, Richard; Conlon, Kevin C.; Fernández‐Cruz, Laureano; Fingerhut, Abe; Frieß, Helmut; Izbicki, Jakob R.; Lillemoe, Keith D.; Neoptolemos, John P.; Sarr, Michael G.; Shrikhande, Shailesh V.; Sitarz, Robert; Vollmer, Charles M.; Yeo, Charles J.; Hartwig, Werner; Wolfgang, Christopher L.; Gouma, Dirk J.

doi:10.1016/j.surg.2016.06.058

Cited by 257 publications

(198 citation statements)

References 33 publications

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“…Postoperative morbidity, including postoperative pancreatic fistula (POPF) [18], delayed gastric emptying (DGE) [19], chyle leak [20], and hemorrhage [21], was assessed according to the definitions of International Study Group of Pancreatic Surgery. Postoperative mortality was defined as death before hospital discharge or within 30 days after the operation.…”

Section: Patient Databasementioning

confidence: 99%

Central pancreatectomy for early-stage pancreatic ductal adenocarcinoma: a single-center case–control study

Gao

Liu

Wang

et al. 2019

Langenbecks Arch Surg

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Purpose Central pancreatectomy (CP) has been applied for treating benign and low-grade malignant tumors in pancreatic neck, but studies regarding CP for pancreatic ductal adenocarcinoma (PDAC) are quite limited. We aimed to investigate the role of central pancreatectomy in the treatment of PDAC in the neck of the pancreas. Methods Patients who underwent CP at our hospital between 2009 and 2016 were identified. Patients treated by distal pancreatectomy (DP) were matched according to the tumor size, location, and staging. The surgical and survival outcomes were compared between the CP and DP groups. Results Nine patients had CP. Five (56%) had postoperative complications and three (33%) had clinically significant (grade B + C) fistula. No significant difference was found between the CP and DP groups for the rate of overall morbidity, pancreatic fistula, reoperation, and readmission. Tumor size was smaller in the CP group compared to the DP group. The mortality of both groups was zero. The median postoperative survival was similar between the two groups (20.4 months for CP vs 19.4 months for DP, P = 0.842). Conclusions CP is safe for patients with small PDAC at the neck of the pancreas. Considering the good preservation of pancreatic endocrine and exocrine functions, CP could be considered as an alternative procedure for single small PDAC in pancreatic neck.

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Section: Patient Databasementioning

confidence: 99%

Central pancreatectomy for early-stage pancreatic ductal adenocarcinoma: a single-center case–control study

Gao

Liu

Wang

et al. 2019

Langenbecks Arch Surg

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“…The severity of fistula was further categorized in accordance with the recently updated classification by the International Study Group on Pancreatic Surgery (ISGPS) [10]. DGE, PPH, and chyle leak were also verified as per the ISGPS definitions [11][12][13]. In addition, bile leakage was defined and classified according to the severity grading system of the International Study Group for Liver Surgery definition of bile leak [14].…”

Section: Definitionsmentioning

confidence: 99%

Upfront pancreaticoduodenectomy in severely jaundiced patients: is it safe?

Pamecha

Patil

Kumar

et al. 2019

J Hepato Biliary Pancreat

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Aim The aim of this study was to evaluate the outcomes following upfront pancreaticoduodenectomy (PD) in severely jaundiced (serum bilirubin level ≥15 mg/dl) patients with malignant distal common bile duct (CBD) obstruction. Background Recent studies have failed to show the benefits of preoperative biliary drainage (PBD) before PD. In addition, there is limited data on the impact of upfront PD on perioperative outcomes in severely jaundiced patients. Methods We reviewed the prospectively collected data of 177 patients who had undergone PD for the malignant distal CBD obstruction from May 2009 to May 2018. Study subjects were divided into Group A (severely jaundiced patients with upfront PD; n = 20), Group B (patients with serum bilirubin <15 mg/dl and no PBD; n = 88) and Group C (PBD prior to PD; n = 69). Overall morbidity, in-hospital mortality, and postoperative hospital stay were compared. Results No significant differences were noted between the three groups regarding sex, tumor size and stage, comorbidities, and surgical technique. The intra-operative blood loss was more in severely jaundiced patients as compared to Groups B and C (605 vs. 300 vs. 350 ml, P = 0.0001), but similar operative times, blood transfusions, and rates of post-pancreatectomy leak and hemorrhage.The infective complications were significantly less with upfront surgery. The overall morbidity, in-hospital mortality, and hospital stay were comparable between the three groups. Multiple logistic regression analysis failed to identify both the presence of preoperative jaundice and hyperbilirubinemia ≥15 mg/dl as independent risk factors for post-PD major morbidity. Conclusion Upfront PD can be performed safely in the selected severely jaundiced patients and is associated with significantly lower infective complications.

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“…21 Consensus statements by the International Study Group of Pancreatic Surgery (ISGPS) were used to evaluate specific complications. [22][23][24] Postoperative complications were classified according to the Clavien-Dindo system, 25,26 and complications of grade III or greater were considered as major. 27 Any death in hospital or within 90 days after surgery was defined as perioperative mortality.…”

Section: Data Collection and Definition Of Variablesmentioning

confidence: 99%

Total pancreatectomy for pancreatic malignancy with preservation of the spleen

Yang

Jin

Warshaw

et al. 2019

Journal of Surgical Oncology

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Background Total pancreatectomy may be necessary to achieve margin‐negative resection for pancreatic cancer. However, despite the desirability of saving the spleen, the feasibility, safety, and oncological outcomes of spleen‐preserving total pancreatectomy have not been studied in patients with malignancy involving the pancreatic neck or proximal body. The aim of this study was to report the efficacy of spleen‐preserving total pancreatectomy using the Warshaw technique for patients with pancreatic malignancies. Methods A retrospective analysis of patients who underwent total pancreatectomy for malignant pancreatic diseases between December 2006 and January 2018 focused on comparing the clinical outcomes between conventional operations with splenectomy and spleen‐preserving total pancreatectomy using the Warshaw technique. Results Thirty‐eight patients among a total of 59 total pancreatectomies had the spleen preservation by the Warshaw operation. In this series, the pancreatic ductal adenocarcinomas resected with the Warshaw technique were of smaller tumor size but had greater rates of vascular invasion, resulting in the more frequent vascular resection. No patients had splenic complications requiring splenectomy, but two patients intended to have the Warshaw operation were converted to splenectomy because of splenic malperfusion. Asymptomatic perigastric varices were noted in 4 patients. Postoperative morbidity and mortality were comparable between the Warshaw and conventional operation groups. Recurrence‐free and overall survival was similar in both groups. Conclusion In patients with pancreatic malignancy, total pancreatectomy with preservation of the spleen using the Warshaw technique achieves outcomes comparable with conventional total pancreatectomy with splenectomy in selected patients.

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Definition and classification of chyle leak after pancreatic operation: A consensus statement by the International Study Group on Pancreatic Surgery

Cited by 257 publications

References 33 publications

Central pancreatectomy for early-stage pancreatic ductal adenocarcinoma: a single-center case–control study

Central pancreatectomy for early-stage pancreatic ductal adenocarcinoma: a single-center case–control study

Upfront pancreaticoduodenectomy in severely jaundiced patients: is it safe?

Total pancreatectomy for pancreatic malignancy with preservation of the spleen

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