Chyle leakage after robotic and open pancreaticoduodenectomy

Shyr, Bor‐Uei; Shyr, Bor‐Shiuan; Chen, Shih‐Chin; Shyr, Yi‐Ming; Wang, Shin‐E

doi:10.1002/jhbp.716

Cited by 15 publications

(15 citation statements)

References 16 publications

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“…However, the chyle leakage rate was high, with 25.0% overall and 19.1% and 30.5% in the early and late groups, respectively. The association between level III mesopancreas dissections and chyle leakage was described in our previous study 8,27 . As expected, the more level III mesopancreas dissections, the greater the chyle leakage, especially in the late group, as shown in this RPD series.…”

Section: Discussionsupporting

confidence: 84%

“…The association between level III mesopancreas dissections and chyle leakage was described in our previous study. 8,27 As expected, the more level III mesopancreas dissections, the greater the chyle leakage, especially in the late group, as shown in this RPD series. After the learning curve was overcome as shown in our previous study, 28 the present study demonstrated that RPD is feasible and safe over time.…”

Section: -Year Survival (%) P-valuesupporting

confidence: 78%

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Reappraisal of surgical and survival outcomes of 500 consecutive cases of robotic pancreaticoduodenectomy

Shyr,

Chen

et al. 2023

J Hepato Biliary Pancreat

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BackgroundThe role of the robotic approach for pancreaticoduodenectomy has not been well established with robust data. This study aimed to reappraise feasibility and justification of robotic pancreaticoduodenectomy (RPD) over time.MethodsA total of 500 patients undergoing RPD were enrolled and divided into early (first 250 patients) and late (last 250 patients) groups for a comparative study.ResultsThe conversion rate was 8.8% overall and was significantly lower in the late group (5.6% vs. 12.0%; p = .012). The overall median intraoperative blood loss was 130 mL. Radicality of resection was similar between early and late groups. The overall surgical mortality after RPD was 1.3%. The overall surgical morbidity and major complication was 44.1% and 13.2%, respectively, and similar between early and late groups. Chyle leakage was the most common complication after RPD (25.0%), followed by postoperative pancreatic fistula (POPF). The POPF rate was 8.6% overall, with 5.9% in the early group and 11.0% in the late group, p = .051. The overall delayed gastric emptying rate was 3.5%. The late group had better survival outcomes than those of the early group after RPD for ampullary adenocarcinoma (p = .027) but not for pancreatic head adenocarcinoma.ConclusionsReappraisal of this study has confirmed that RPD is not only technically feasible without increasing surgical risks but also oncologically justified without compromising survival outcomes for both pancreatic head and other periampullary cancers over time. Moreover, RPD is associated with the benefits of low surgical mortality, blood loss, and delayed gastric emptying.

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Section: Discussionsupporting

confidence: 84%

Section: -Year Survival (%) P-valuesupporting

confidence: 78%

Reappraisal of surgical and survival outcomes of 500 consecutive cases of robotic pancreaticoduodenectomy

Shyr,

Chen

et al. 2023

J Hepato Biliary Pancreat

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“…In the present study, the duration median was 8, 3, or 7 days in hepatobiliary surgery, gastrointestinal surgery, and urological surgery. For gynecological surgery patients with chylous leakage cured by TPN alone, the median was 15 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16) days (60). The median for days of drainage was 3 (1-21) days (3 cases discharged with a drainage tube on day 1 of intervention and 1 on day 2) in the present study under a similar condition.…”

Section: Discussionmentioning

confidence: 99%

The application of a medium-chain fatty diet and enteral nutrition in post-operative chylous leakage: analysis of 63 patients

Wang

Xiao

et al. 2023

Front. Nutr.

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BackgroundPost-operative chylous leakage (CL) is the pathologic leakage of chylomicron fluid after surgery. This retrospective study was performed to evaluate a uniform oral nutrition management strategy on the post-operative CL.MethodsWe retrospectively reviewed patients who developed post-operative CL and received consultation from a clinical nutritionist in seven departments of the Second Affiliated Hospital of Dalian Medical University from May 2020 to April 2022. We designed the oral nutrition intervention program which mainly standardized the type and amount of foods contained in the medium-chain triglyceride (MCT) diet. The influencing factors of curative efficacy were analyzed. Finally, binary logistic regression analysis was conducted to observe the relationship between curative efficacy and potentially predictive variables, including post-operative albumin, post-operative hemoglobin, surgical procedure, and drainage volume at consultation.ResultsSixty-three patients with post-operative CL were included in this analysis. Of this number, 58 patients were cured successfully without other treatments. Three patients had a significantly prolonged recovery period, and the remaining two cases were treated by reoperation therapy. The leakage volume at the initiation of enteral intervention had no statistically significant difference in seven surgical departments and surgical sites (left, right, median, and bilateral). The length of stay (LOS) of patients with CL after the intervention was not significantly increased in cardiac, hepatobiliary, gastrointestinal, and urological surgeries. Patients with CL had longer LOS than those without CL in gynecology (P=0.044) and thyroid surgery departments (P=0.008). Each unit increase in post-operative hemoglobin would increase the probability of an effective outcome by 8%, which was statistically significant (P = 0.037).ConclusionIn treating patients with post-operative CL, we recommend the MCT diet and EN as the first option, rather than fasting, parenteral nutrition (PN), or octreotide.

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“…A single-center retrospective study specifically investigating CL in open (n = 118) versus robot PD (n = 165), found no effect of the surgical approach on CL (10.9% vs 13.6%, P = 0.449). 28 In the 4 randomized trials on laparoscopic versus open PD, only the multicenter randomized LEOPARD-2 trial reported on the incidence of CL. [29][30][31][32] A nonsignificant increase in CL after laparoscopic as compared with open PD (n = 2/50 [4%] vs n = 7/49 [14%], P = 0.09) was reported.…”

Section: Discussionmentioning

confidence: 99%

“…The literature is conflicting on this point. A single-center retrospective study specifically investigating CL in open (n=118) versus robot PD (n=165), found no effect of the surgical approach on CL (10.9% vs 13.6%, P =0.449) 28. In the 4 randomized trials on laparoscopic versus open PD, only the multicenter randomized LEOPARD-2 trial reported on the incidence of CL 29–32.…”

Section: Discussionmentioning

confidence: 99%

Chyle Leak After Pancreatoduodenectomy

et al. 2022

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Objective: The aim of this study was to assess the clinical impact and risk factors of chyle leak (CL). Background: In 2017, the International Study Group for Pancreatic Surgery (ISGPS) published the consensus definition of CL. Multicenter series validating this definition are lacking and previous studies investigating risk factors have used different definitions and showed heterogeneous results. Methods: This observational cohort study included all consecutive patients after pancreatoduodenectomy in all 19 centers in the mandatory nationwide Dutch Pancreatic Cancer Audit (2017–2019). The primary endpoint was CL (ISGPS grade B/C). Multivariable logistic regression analyses were performed. Results: Overall, 2159 patients after pancreatoduodenectomy were included. The rate of CL was 7.0% (n=152), including 6.9% (n=150) grade B and 0.1% (n=2) grade C. CL was independently associated with a prolonged hospital stay [odds ratio (OR)=2.84, 95% confidence interval (CI): 1.85–4.36, P <0.001] but not with mortality (OR=0.3, 95% CI: 0.0–2.3, P =0.244). In multivariable analyses, independent predictors for CL were vascular resection (OR=2.1, 95% CI: 1.4–3.2, P <0.001) and open surgery (OR=3.5, 95% CI: 1.7–7.2, P =0.001). The number of resected lymph nodes and aortocaval lymph node sampling were not identified as predictors in multivariable analysis. Conclusions: In this nationwide analysis, the rate of ISGPS grade B/C CL after pancreatoduodenectomy was 7.0%. Although CL is associated with a prolonged hospital stay, the clinical impact is relatively minor in the vast majority (>98%) of patients. Vascular resection and open surgery are predictors of CL.

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Chyle leakage after robotic and open pancreaticoduodenectomy

Cited by 15 publications

References 16 publications

Reappraisal of surgical and survival outcomes of 500 consecutive cases of robotic pancreaticoduodenectomy

Reappraisal of surgical and survival outcomes of 500 consecutive cases of robotic pancreaticoduodenectomy

The application of a medium-chain fatty diet and enteral nutrition in post-operative chylous leakage: analysis of 63 patients

Chyle Leak After Pancreatoduodenectomy

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