Incidence and risk factors for Chyle leak after pancreatic surgery for cancer: A comprehensive systematic review |
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| Affiliation: | 1. AP-HP, Department of Digestive and Oncologic Surgery, Ambroise Paré Hospital, 9 Avenue Charles de Gaulle, 92104, Boulogne-Billancourt, France;2. Department of Surgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil;3. Versailles St-Quentin-en-Yvelines/Paris Saclay University, UFR des Sciences de la Santé Simone Veil, 78180, Montigny-le-Bretonneux, France;4. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA;5. Department of Surgery, Saint Antoine Hospital, 184 Rue du Faubourg Saint Antoine, 75012, Paris, France;6. Sorbonne Université, 75013, 91-105, Bd de l''Hôpital, Paris, France;1. Department of Surgical Oncology, Comprehensive Cancer Center, Institut de Cancérologie de l’Ouest, France;2. Department of Medical Oncology, Comprehensive Cancer Center, Institut de Cancérologie de l’Ouest, France;1. Department of Surgery, Beaumont Hospital, Dublin 9, Ireland;2. National Cancer Control Program Ireland, King''s Inn House, Dublin 1, Ireland;3. National Cancer Registry of Ireland, Kinsale Road, Cork, Ireland;4. Department of Surgery, Royal College of Surgeons in Ireland, Dublin 2, Ireland;1. Department of General-, Visceral- and Transplant Surgery, UNIVERSITY MEDICAL CENTER of the Johannes Gutenberg University, Mainz, Germany;2. Department of Visceral, Transplant-, Thoracic- and Vascular Surgery, Department of Operative Medicine (DOPM), University Hospital of Leipzig, Leipzig, Germany;3. Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands;1. Department of Thoracic Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, PR China;2. VIP Region, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, PR China;3. The Second Department of Surgery, Sun Yat-sen University Sixth Affiliated Hospital, Guangzhou, Guangdong, PR China;4. Department of Laboratory Medicine, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, PR China;1. Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China;2. Division of Thoracic Surgery, Department of Cardiothoracic Surgery and Vascular Sciences, Padua University Hospital, University of Padua, Padua, Italy;3. Department of Thoracic Surgery, Poznan University of Medical Sciences, Poznan, Poland;4. Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy;5. Thoracic Surgery Unit, Department of Thoracic Diseases, University of Bologna, G.B. Morgagni-L. Pierantoni Hospital, Forlì, Italy;6. Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy |
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| Abstract: | BackgroundChyle leak (CL) is a clinically relevant complication after pancreatectomy. Its incidence and the associated risk factors are ill defined, and various treatments options have been described. There is no consensus, however, regarding optimal management. The present study aims to systematically review the literature on CL after pancreatectomy.MethodsA systematic review from PubMed, Scopus and Embase database was performed. Studies using a clear definition for CL and published from January 2000 to January 2021 were included. The PRISMA guidelines were followed during all stages of this systematic review. The MINORS score was used to assess methodological quality.ResultsLiterature search found 361 reports, 99 of which were duplicates. The titles and abstracts of 262 articles were finally screened. The references from the remaining 181 articles were manually assessed. After the exclusions, 43 articles were thoroughly assessed. A total of 23 articles were ultimately included for this review. The number of patients varied from 54 to 3532. Incidence of post pancreatectomy CL varied from 1.3% to 22.1%. Main risk factors were the extent of the surgery and early oral or enteral feeding. CL dried up spontaneously or after conservative management within 14 days in 53% to 100% of the cases.ConclusionsThe extent of surgery is the most common predictor of risk of CL. Conservative treatment has been shown to be effective in most cases and can be considered the treatment of choice. We propose a management algorithm based on the current available evidence. |
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| Keywords: | Chyle leak Pancreas Surgery Complication Postoperative CL" },{" #name" :" keyword" ," $" :{" id" :" kwrd0040" }," $$" :[{" #name" :" text" ," _" :" Chyle Leak POPF" },{" #name" :" keyword" ," $" :{" id" :" kwrd0050" }," $$" :[{" #name" :" text" ," _" :" Postoperative pancreatic fistula DGE" },{" #name" :" keyword" ," $" :{" id" :" kwrd0060" }," $$" :[{" #name" :" text" ," _" :" Delayed gastric emptying (DGE) ISGPS" },{" #name" :" keyword" ," $" :{" id" :" kwrd0070" }," $$" :[{" #name" :" text" ," _" :" International Study Group on Pancreatic Surgery PROSPERO" },{" #name" :" keyword" ," $" :{" id" :" kwrd0080" }," $$" :[{" #name" :" text" ," _" :" International Prospective Register of Systematic Reviews PD" },{" #name" :" keyword" ," $" :{" id" :" kwrd0090" }," $$" :[{" #name" :" text" ," _" :" Pancreatoduodenectomy DP" },{" #name" :" keyword" ," $" :{" id" :" kwrd0100" }," $$" :[{" #name" :" text" ," _" :" Distal pancreatectomy TP" },{" #name" :" keyword" ," $" :{" id" :" kwrd0110" }," $$" :[{" #name" :" text" ," _" :" Total pancreatectomy PRISMA" },{" #name" :" keyword" ," $" :{" id" :" kwrd0120" }," $$" :[{" #name" :" text" ," _" :" Preferred Reporting Items for Systematic Reviews and Meta-Analyses MINORS" },{" #name" :" keyword" ," $" :{" id" :" kwrd0130" }," $$" :[{" #name" :" text" ," _" :" Methodological Index for Non-Randomized Studies TG" },{" #name" :" keyword" ," $" :{" id" :" kwrd0140" }," $$" :[{" #name" :" text" ," _" :" Triglyceride POD" },{" #name" :" keyword" ," $" :{" id" :" kwrd0150" }," $$" :[{" #name" :" text" ," _" :" Post-operative day OR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0160" }," $$" :[{" #name" :" text" ," _" :" Odds ratio MCT" },{" #name" :" keyword" ," $" :{" id" :" kwrd0170" }," $$" :[{" #name" :" text" ," _" :" Medium-chain tryglyceride LCT" },{" #name" :" keyword" ," $" :{" id" :" kwrd0180" }," $$" :[{" #name" :" text" ," _" :" Low-chain triglyceride LOS" },{" #name" :" keyword" ," $" :{" id" :" kwrd0190" }," $$" :[{" #name" :" text" ," _" :" Length of hospital stay TPN" },{" #name" :" keyword" ," $" :{" id" :" kwrd0200" }," $$" :[{" #name" :" text" ," _" :" Total parenteral nutrition BPLAG" },{" #name" :" keyword" ," $" :{" id" :" kwrd0210" }," $$" :[{" #name" :" text" ," _" :" Bipedal lymphangiography |
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