Incidence and Management of Chyle Leaks Following Pancreatic Resection: A High Volume Single-Center Institutional Experience

Assumpção, Lia; Cameron, John L.; Wolfgang, Christopher L.; Edil, Barish H.; Choti, Michael A.; Herman, Joseph M.; Geschwind, Jean François H.; Hong, Kelvin; Georgiades, Christos; Schulick, Richard D.; Pawlik, Timothy M.

doi:10.1007/s11605-008-0619-3

Cited by 108 publications

(164 citation statements)

References 36 publications

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“…Large clinical studies have been conducted recently, however, especially of cases following pancreatic resection. According to such reports, rates of chylous ascites incidence after pancreatoduodenectomy ranged from 1.8 to 13% [9,10,11]. Our results indicated rates of 7.7% for all pancreatectomies and 5.0% for pancreaticoduodenectomies.…”

Section: Discussionsupporting

confidence: 48%

“…Although there were no significant differences, Assumpcao et al [9] reported that patients with chylous ascites tended to have worse long-term survival. They distinguished chylous ascites from chylous leak.…”

Section: Discussionmentioning

confidence: 98%

“…In a report by Assumpcao et al [9], 47 patients (1.3%) developed chyle leaks after 3,532 cases of pancreatectomy surgery. Further, 46 patients (1.8%) developed the condition after 2,589 cases of pancreatoduodenectomy, and only 1 patient (0.1%) after 711 cases of distal pancreatectomy.…”

Section: Discussionmentioning

confidence: 99%

“…The reason why chyle leaks tend to be found a day or two after the start of postoperative oral intake is thus clear. Assumpcao et al [9] showed that the median time to chyle leak presentation following resection was 5 days (range 4–8) and van der Gaag et al [10] indicated a median time of 6 days (range 3–52). Both reports, however, failed to clarify the date of commencement of oral intake of meals.…”

Section: Discussionmentioning

confidence: 99%

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Milk-Based Test as a Preventive Method for Chylous Ascites following Pancreatic Resection

Aoki

Takakura

Shiozaki³

et al. 2010

Dig Surg

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Background/Purpose: The incidence and natural history of postoperative chylous ascites are not well understood. This complication causes malnutrition and prolonged hospital stay. We investigated our institution’s experience involving chylous ascites, especially following pancreatectomy. Additionally, we designed a new intraoperative method dubbed the ‘milk test’ for preventing chylous ascites. Methods: Five cases of chylous ascites following pancreatectomy from April 2001 through March 2004 were studied retrospectively. The milk test was carried out prospectively. Such rates as positivity and incidence of ascites were examined. Results: Of 65 cases (40 pancreatoduodenectomy; 25 distal pancreatectomy), 5 (7.7%) developed chylous ascites following pancreatic resection. All cases underwent octreotide and total parenteral nutrition treatment. From April 2004 through March 2009, the milk test was used in 104 cases. Surgical procedures comprised pancreatoduodenectomy (n = 78) and distal pancreatectomy (n = 23). Of these cases, 23 (22.1%) tested positive. No significant difference in positive rates was observed between the procedures and diseases. After initiation of the milk test, chylous ascites incidence decreased from 7.7 to 2.9%. Conclusions: For chylous ascites, octreotide and total parenteral nutrition treatments are useful. However, the milk test was found to be a safe and effective method for prevention of chylous ascites following pancreatectomy.

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Section: Discussionsupporting

confidence: 48%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Milk-Based Test as a Preventive Method for Chylous Ascites following Pancreatic Resection

Aoki

Takakura

Shiozaki³

et al. 2010

Dig Surg

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“…Recent technical developments have reduced the mortality rate to less than 2% [2,4], while the morbidity rate remains high (30-50%) [3] even at high-volume centers. Bleeding [5], postoperative pancreatic fistula (POPF) [6], delayed gastric emptying (DGE) [7], and chylous ascites [8] have been reported as post-PD complications. Additionally, nonchylous massive discharge is frequently encountered in patients undergoing PD after standard or extensive lymph node dissection.…”

mentioning

confidence: 99%

Predictors of Postoperative Non-Chylous Massive Discharge after Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma

Ito

Kawaguchi²,

Sakamoto³

et al. 2017

Dig Surg

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Background: Pancreaticoduodenectomy (PD) is performed for pancreatic ductal adenocarcinoma (PDA) located at the pancreas head/body. Non-chylous massive discharge after PD is frequently encountered and can cause a vicious cycle of complications associated with severe dehydration and protein loss. Methods: From August 2008 to June 2015, 102 patients who underwent PD for PDA were retrospectively reviewed. High non-chylous discharge was defined as postoperative daily serous discharge exceeding 10 mL/kg. Predictive factors for high non-chylous discharge were assessed using multivariable analysis. Results: Fifty-one patients (50%) developed high non-chylous discharge. Body mass index (BMI) and hemoglobin, total protein, and cholinesterase levels were significantly lower in the high-discharge group compared to the corresponding levels in the low-discharge group. The incidence of postoperative pancreatic fistula and delayed gastric emptying was significantly lower and higher in the high-discharge group than in the low-discharge group, respectively. Multivariable analysis revealed that BMI <22.0 kg/m², hemoglobin <12.0 g/dL and intraoperative blood loss ≥800 mL were independent predictive factors for high non-chylous discharge. Conclusions: Preoperative low levels of BMI and hemoglobin and intraoperative high blood loss were independent predictive factors for high non-chylous discharge. Improvement of preoperative general and nutritional condition may reduce the incidence of high non-chylous discharge.

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Nutrition in Upper Gastrointestinal Cancer

Chowdhury¹,

Hynes²

2010

Nutrition and Cancer

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Incidence and Management of Chyle Leaks Following Pancreatic Resection: A High Volume Single-Center Institutional Experience

Cited by 108 publications

References 36 publications

Milk-Based Test as a Preventive Method for Chylous Ascites following Pancreatic Resection

Milk-Based Test as a Preventive Method for Chylous Ascites following Pancreatic Resection

Predictors of Postoperative Non-Chylous Massive Discharge after Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma

Nutrition in Upper Gastrointestinal Cancer

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