Definition and classification of chyle leak after pancreatic operation: A consensus statement by the International Study Group on Pancreatic Surgery
Background Recent literature suggests that chyle leak may complicate up to 10% of pancreatic resections. Treatment depends on its severity, which may include chylous ascites. No international consensus definition or grading system of chyle leak currently is available. Methods The International Study...
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| creator | Besselink, Marc G., MD van Rijssen, L. Bengt, MD Bassi, Claudio, MD Dervenis, Christos, MD Montorsi, Marco, MD Adham, Mustapha, MD Asbun, Horacio J., MD Bockhorn, Maximillian, MD Strobel, Oliver, MD Büchler, Markus W., MD Busch, Olivier R., MD Charnley, Richard M., MD Conlon, Kevin C., MD Fernández-Cruz, Laureano, MD Fingerhut, Abe, MD Friess, Helmut, MD Izbicki, Jakob R., MD Lillemoe, Keith D., MD Neoptolemos, John P., MD Sarr, Michael G., MD Shrikhande, Shailesh V., MD Sitarz, Robert, MD Vollmer, Charles M., MD Yeo, Charles J., MD Hartwig, Werner, MD Wolfgang, Christopher L., MD Gouma, Dirk J., MD |
| description | Background Recent literature suggests that chyle leak may complicate up to 10% of pancreatic resections. Treatment depends on its severity, which may include chylous ascites. No international consensus definition or grading system of chyle leak currently is available. Methods The International Study Group on Pancreatic Surgery, an international panel of pancreatic surgeons working in well-known, high-volume centers, reviewed the literature and worked together to establish a consensus on the definition and classification of chyle leak after pancreatic operation. Results Chyle leak was defined as output of milky-colored fluid from a drain, drain site, or wound on or after postoperative day 3, with a triglyceride content ≥110 mg/dL (≥1.2 mmol/L). Three different grades of severity were defined according to the management needed: grade A, no specific intervention other than oral dietary restrictions; grade B, prolongation of hospital stay, nasoenteral nutrition with dietary restriction, total parenteral nutrition, octreotide, maintenance of surgical drains, or placement of new percutaneous drains; and grade C, need for other more invasive in-hospital treatment, intensive care unit admission, or mortality. Conclusion This classification and grading system for chyle leak after pancreatic resection allows for comparison of outcomes between series. As with the other the International Study Group on Pancreatic Surgery consensus statements, this classification should facilitate communication and evaluation of different approaches to the prevention and treatment of this complication. |
| doi_str_mv | 10.1016/j.surg.2016.06.058 |
| format | Article |
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Bengt, MD ; Bassi, Claudio, MD ; Dervenis, Christos, MD ; Montorsi, Marco, MD ; Adham, Mustapha, MD ; Asbun, Horacio J., MD ; Bockhorn, Maximillian, MD ; Strobel, Oliver, MD ; Büchler, Markus W., MD ; Busch, Olivier R., MD ; Charnley, Richard M., MD ; Conlon, Kevin C., MD ; Fernández-Cruz, Laureano, MD ; Fingerhut, Abe, MD ; Friess, Helmut, MD ; Izbicki, Jakob R., MD ; Lillemoe, Keith D., MD ; Neoptolemos, John P., MD ; Sarr, Michael G., MD ; Shrikhande, Shailesh V., MD ; Sitarz, Robert, MD ; Vollmer, Charles M., MD ; Yeo, Charles J., MD ; Hartwig, Werner, MD ; Wolfgang, Christopher L., MD ; Gouma, Dirk J., MD</creator><creatorcontrib>Besselink, Marc G., MD ; van Rijssen, L. Bengt, MD ; Bassi, Claudio, MD ; Dervenis, Christos, MD ; Montorsi, Marco, MD ; Adham, Mustapha, MD ; Asbun, Horacio J., MD ; Bockhorn, Maximillian, MD ; Strobel, Oliver, MD ; Büchler, Markus W., MD ; Busch, Olivier R., MD ; Charnley, Richard M., MD ; Conlon, Kevin C., MD ; Fernández-Cruz, Laureano, MD ; Fingerhut, Abe, MD ; Friess, Helmut, MD ; Izbicki, Jakob R., MD ; Lillemoe, Keith D., MD ; Neoptolemos, John P., MD ; Sarr, Michael G., MD ; Shrikhande, Shailesh V., MD ; Sitarz, Robert, MD ; Vollmer, Charles M., MD ; Yeo, Charles J., MD ; Hartwig, Werner, MD ; Wolfgang, Christopher L., MD ; Gouma, Dirk J., MD ; International Study Group on Pancreatic Surgery</creatorcontrib><description>Background Recent literature suggests that chyle leak may complicate up to 10% of pancreatic resections. Treatment depends on its severity, which may include chylous ascites. No international consensus definition or grading system of chyle leak currently is available. Methods The International Study Group on Pancreatic Surgery, an international panel of pancreatic surgeons working in well-known, high-volume centers, reviewed the literature and worked together to establish a consensus on the definition and classification of chyle leak after pancreatic operation. Results Chyle leak was defined as output of milky-colored fluid from a drain, drain site, or wound on or after postoperative day 3, with a triglyceride content ≥110 mg/dL (≥1.2 mmol/L). Three different grades of severity were defined according to the management needed: grade A, no specific intervention other than oral dietary restrictions; grade B, prolongation of hospital stay, nasoenteral nutrition with dietary restriction, total parenteral nutrition, octreotide, maintenance of surgical drains, or placement of new percutaneous drains; and grade C, need for other more invasive in-hospital treatment, intensive care unit admission, or mortality. Conclusion This classification and grading system for chyle leak after pancreatic resection allows for comparison of outcomes between series. As with the other the International Study Group on Pancreatic Surgery consensus statements, this classification should facilitate communication and evaluation of different approaches to the prevention and treatment of this complication.</description><identifier>ISSN: 0039-6060</identifier><identifier>EISSN: 1532-7361</identifier><identifier>DOI: 10.1016/j.surg.2016.06.058</identifier><identifier>PMID: 27692778</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Anastomosis, Surgical - adverse effects ; Anastomosis, Surgical - methods ; Anastomotic Leak - classification ; Anastomotic Leak - therapy ; Chylous Ascites - classification ; Chylous Ascites - etiology ; Chylous Ascites - therapy ; Consensus ; Female ; Humans ; Internationality ; Male ; Pancreatectomy - adverse effects ; Pancreatectomy - methods ; Pancreatic Neoplasms - surgery ; Postoperative Complications - classification ; Postoperative Complications - therapy ; Prognosis ; Risk Assessment ; Severity of Illness Index ; Surgery ; Treatment Outcome</subject><ispartof>Surgery, 2017-02, Vol.161 (2), p.365-372</ispartof><rights>Elsevier Inc.</rights><rights>2016 Elsevier Inc.</rights><rights>Copyright © 2016 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c477t-39e7824e57254170ea52a3bc60ca2f205c59b6ab16984527c6a4d592ae53b0193</citedby><cites>FETCH-LOGICAL-c477t-39e7824e57254170ea52a3bc60ca2f205c59b6ab16984527c6a4d592ae53b0193</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0039606016304172$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27692778$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Besselink, Marc G., MD</creatorcontrib><creatorcontrib>van Rijssen, L. Bengt, MD</creatorcontrib><creatorcontrib>Bassi, Claudio, MD</creatorcontrib><creatorcontrib>Dervenis, Christos, MD</creatorcontrib><creatorcontrib>Montorsi, Marco, MD</creatorcontrib><creatorcontrib>Adham, Mustapha, MD</creatorcontrib><creatorcontrib>Asbun, Horacio J., MD</creatorcontrib><creatorcontrib>Bockhorn, Maximillian, MD</creatorcontrib><creatorcontrib>Strobel, Oliver, MD</creatorcontrib><creatorcontrib>Büchler, Markus W., MD</creatorcontrib><creatorcontrib>Busch, Olivier R., MD</creatorcontrib><creatorcontrib>Charnley, Richard M., MD</creatorcontrib><creatorcontrib>Conlon, Kevin C., MD</creatorcontrib><creatorcontrib>Fernández-Cruz, Laureano, MD</creatorcontrib><creatorcontrib>Fingerhut, Abe, MD</creatorcontrib><creatorcontrib>Friess, Helmut, MD</creatorcontrib><creatorcontrib>Izbicki, Jakob R., MD</creatorcontrib><creatorcontrib>Lillemoe, Keith D., MD</creatorcontrib><creatorcontrib>Neoptolemos, John P., MD</creatorcontrib><creatorcontrib>Sarr, Michael G., MD</creatorcontrib><creatorcontrib>Shrikhande, Shailesh V., MD</creatorcontrib><creatorcontrib>Sitarz, Robert, MD</creatorcontrib><creatorcontrib>Vollmer, Charles M., MD</creatorcontrib><creatorcontrib>Yeo, Charles J., MD</creatorcontrib><creatorcontrib>Hartwig, Werner, MD</creatorcontrib><creatorcontrib>Wolfgang, Christopher L., MD</creatorcontrib><creatorcontrib>Gouma, Dirk J., MD</creatorcontrib><creatorcontrib>International Study Group on Pancreatic Surgery</creatorcontrib><title>Definition and classification of chyle leak after pancreatic operation: A consensus statement by the International Study Group on Pancreatic Surgery</title><title>Surgery</title><addtitle>Surgery</addtitle><description>Background Recent literature suggests that chyle leak may complicate up to 10% of pancreatic resections. Treatment depends on its severity, which may include chylous ascites. No international consensus definition or grading system of chyle leak currently is available. Methods The International Study Group on Pancreatic Surgery, an international panel of pancreatic surgeons working in well-known, high-volume centers, reviewed the literature and worked together to establish a consensus on the definition and classification of chyle leak after pancreatic operation. Results Chyle leak was defined as output of milky-colored fluid from a drain, drain site, or wound on or after postoperative day 3, with a triglyceride content ≥110 mg/dL (≥1.2 mmol/L). Three different grades of severity were defined according to the management needed: grade A, no specific intervention other than oral dietary restrictions; grade B, prolongation of hospital stay, nasoenteral nutrition with dietary restriction, total parenteral nutrition, octreotide, maintenance of surgical drains, or placement of new percutaneous drains; and grade C, need for other more invasive in-hospital treatment, intensive care unit admission, or mortality. Conclusion This classification and grading system for chyle leak after pancreatic resection allows for comparison of outcomes between series. As with the other the International Study Group on Pancreatic Surgery consensus statements, this classification should facilitate communication and evaluation of different approaches to the prevention and treatment of this complication.</description><subject>Anastomosis, Surgical - adverse effects</subject><subject>Anastomosis, Surgical - methods</subject><subject>Anastomotic Leak - classification</subject><subject>Anastomotic Leak - therapy</subject><subject>Chylous Ascites - classification</subject><subject>Chylous Ascites - etiology</subject><subject>Chylous Ascites - therapy</subject><subject>Consensus</subject><subject>Female</subject><subject>Humans</subject><subject>Internationality</subject><subject>Male</subject><subject>Pancreatectomy - adverse effects</subject><subject>Pancreatectomy - methods</subject><subject>Pancreatic Neoplasms - surgery</subject><subject>Postoperative Complications - classification</subject><subject>Postoperative Complications - therapy</subject><subject>Prognosis</subject><subject>Risk Assessment</subject><subject>Severity of Illness Index</subject><subject>Surgery</subject><subject>Treatment Outcome</subject><issn>0039-6060</issn><issn>1532-7361</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9Ul2L1DAUDaK44-gf8EHy6Etn89GkrYiwrLq7sKAw-hzS9NbNbCYZk1To__AHm86sCj4IF25IzjnhnnMReknJhhIqz3ebNMVvG1bOG1JKtI_QigrOqoZL-hitCOFdJYkkZ-hZSjtCSFfT9ik6Y43sWNO0K_TzPYzW22yDx9oP2Didkh2t0cerMGJzNzvADvQ91mOGiA_amwjl3eBwgHgEvsEX2ASfwKcp4ZR1hj34jPsZ5zvAN74Q_RGpHd7maZjxVQzTAZc_Pv_V25Z5IM7P0ZNRuwQvHvoaff344cvldXX76erm8uK2MnXT5Ip30LSsBtEwUdOGgBZM895IYjQbGRFGdL3UPZVdWwvWGKnrQXRMg-A9oR1fo9cn3UMM3ydIWe1tMuCc9hCmpGjLBS_U0teInaAmhpQijOoQ7V7HWVGiljTUTi1pqCUNRUqJhfTqQX_q9zD8ofy2vwDengBQpvxhIapkLHgDg41gshqC_b_-u3_oxpUwjXb3MEPahamY7socKjFF1HbZh2UdqOSkGMb4L3ltss0</recordid><startdate>20170201</startdate><enddate>20170201</enddate><creator>Besselink, Marc G., MD</creator><creator>van Rijssen, L. 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Bengt, MD ; Bassi, Claudio, MD ; Dervenis, Christos, MD ; Montorsi, Marco, MD ; Adham, Mustapha, MD ; Asbun, Horacio J., MD ; Bockhorn, Maximillian, MD ; Strobel, Oliver, MD ; Büchler, Markus W., MD ; Busch, Olivier R., MD ; Charnley, Richard M., MD ; Conlon, Kevin C., MD ; Fernández-Cruz, Laureano, MD ; Fingerhut, Abe, MD ; Friess, Helmut, MD ; Izbicki, Jakob R., MD ; Lillemoe, Keith D., MD ; Neoptolemos, John P., MD ; Sarr, Michael G., MD ; Shrikhande, Shailesh V., MD ; Sitarz, Robert, MD ; Vollmer, Charles M., MD ; Yeo, Charles J., MD ; Hartwig, Werner, MD ; Wolfgang, Christopher L., MD ; Gouma, Dirk J., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c477t-39e7824e57254170ea52a3bc60ca2f205c59b6ab16984527c6a4d592ae53b0193</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Anastomosis, Surgical - adverse effects</topic><topic>Anastomosis, Surgical - methods</topic><topic>Anastomotic Leak - classification</topic><topic>Anastomotic Leak - therapy</topic><topic>Chylous Ascites - classification</topic><topic>Chylous Ascites - etiology</topic><topic>Chylous Ascites - therapy</topic><topic>Consensus</topic><topic>Female</topic><topic>Humans</topic><topic>Internationality</topic><topic>Male</topic><topic>Pancreatectomy - adverse effects</topic><topic>Pancreatectomy - methods</topic><topic>Pancreatic Neoplasms - surgery</topic><topic>Postoperative Complications - classification</topic><topic>Postoperative Complications - therapy</topic><topic>Prognosis</topic><topic>Risk Assessment</topic><topic>Severity of Illness Index</topic><topic>Surgery</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Besselink, Marc G., MD</creatorcontrib><creatorcontrib>van Rijssen, L. Bengt, MD</creatorcontrib><creatorcontrib>Bassi, Claudio, MD</creatorcontrib><creatorcontrib>Dervenis, Christos, MD</creatorcontrib><creatorcontrib>Montorsi, Marco, MD</creatorcontrib><creatorcontrib>Adham, Mustapha, MD</creatorcontrib><creatorcontrib>Asbun, Horacio J., MD</creatorcontrib><creatorcontrib>Bockhorn, Maximillian, MD</creatorcontrib><creatorcontrib>Strobel, Oliver, MD</creatorcontrib><creatorcontrib>Büchler, Markus W., MD</creatorcontrib><creatorcontrib>Busch, Olivier R., MD</creatorcontrib><creatorcontrib>Charnley, Richard M., MD</creatorcontrib><creatorcontrib>Conlon, Kevin C., MD</creatorcontrib><creatorcontrib>Fernández-Cruz, Laureano, MD</creatorcontrib><creatorcontrib>Fingerhut, Abe, MD</creatorcontrib><creatorcontrib>Friess, Helmut, MD</creatorcontrib><creatorcontrib>Izbicki, Jakob R., MD</creatorcontrib><creatorcontrib>Lillemoe, Keith D., MD</creatorcontrib><creatorcontrib>Neoptolemos, John P., MD</creatorcontrib><creatorcontrib>Sarr, Michael G., MD</creatorcontrib><creatorcontrib>Shrikhande, Shailesh V., MD</creatorcontrib><creatorcontrib>Sitarz, Robert, MD</creatorcontrib><creatorcontrib>Vollmer, Charles M., MD</creatorcontrib><creatorcontrib>Yeo, Charles J., MD</creatorcontrib><creatorcontrib>Hartwig, Werner, MD</creatorcontrib><creatorcontrib>Wolfgang, Christopher L., MD</creatorcontrib><creatorcontrib>Gouma, Dirk J., MD</creatorcontrib><creatorcontrib>International Study Group on Pancreatic Surgery</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Besselink, Marc G., MD</au><au>van Rijssen, L. Bengt, MD</au><au>Bassi, Claudio, MD</au><au>Dervenis, Christos, MD</au><au>Montorsi, Marco, MD</au><au>Adham, Mustapha, MD</au><au>Asbun, Horacio J., MD</au><au>Bockhorn, Maximillian, MD</au><au>Strobel, Oliver, MD</au><au>Büchler, Markus W., MD</au><au>Busch, Olivier R., MD</au><au>Charnley, Richard M., MD</au><au>Conlon, Kevin C., MD</au><au>Fernández-Cruz, Laureano, MD</au><au>Fingerhut, Abe, MD</au><au>Friess, Helmut, MD</au><au>Izbicki, Jakob R., MD</au><au>Lillemoe, Keith D., MD</au><au>Neoptolemos, John P., MD</au><au>Sarr, Michael G., MD</au><au>Shrikhande, Shailesh V., MD</au><au>Sitarz, Robert, MD</au><au>Vollmer, Charles M., MD</au><au>Yeo, Charles J., MD</au><au>Hartwig, Werner, MD</au><au>Wolfgang, Christopher L., MD</au><au>Gouma, Dirk J., MD</au><aucorp>International Study Group on Pancreatic Surgery</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Definition and classification of chyle leak after pancreatic operation: A consensus statement by the International Study Group on Pancreatic Surgery</atitle><jtitle>Surgery</jtitle><addtitle>Surgery</addtitle><date>2017-02-01</date><risdate>2017</risdate><volume>161</volume><issue>2</issue><spage>365</spage><epage>372</epage><pages>365-372</pages><issn>0039-6060</issn><eissn>1532-7361</eissn><abstract>Background Recent literature suggests that chyle leak may complicate up to 10% of pancreatic resections. Treatment depends on its severity, which may include chylous ascites. No international consensus definition or grading system of chyle leak currently is available. Methods The International Study Group on Pancreatic Surgery, an international panel of pancreatic surgeons working in well-known, high-volume centers, reviewed the literature and worked together to establish a consensus on the definition and classification of chyle leak after pancreatic operation. Results Chyle leak was defined as output of milky-colored fluid from a drain, drain site, or wound on or after postoperative day 3, with a triglyceride content ≥110 mg/dL (≥1.2 mmol/L). Three different grades of severity were defined according to the management needed: grade A, no specific intervention other than oral dietary restrictions; grade B, prolongation of hospital stay, nasoenteral nutrition with dietary restriction, total parenteral nutrition, octreotide, maintenance of surgical drains, or placement of new percutaneous drains; and grade C, need for other more invasive in-hospital treatment, intensive care unit admission, or mortality. Conclusion This classification and grading system for chyle leak after pancreatic resection allows for comparison of outcomes between series. As with the other the International Study Group on Pancreatic Surgery consensus statements, this classification should facilitate communication and evaluation of different approaches to the prevention and treatment of this complication.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>27692778</pmid><doi>10.1016/j.surg.2016.06.058</doi><tpages>8</tpages></addata></record> |
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| subjects | Anastomosis, Surgical - adverse effects Anastomosis, Surgical - methods Anastomotic Leak - classification Anastomotic Leak - therapy Chylous Ascites - classification Chylous Ascites - etiology Chylous Ascites - therapy Consensus Female Humans Internationality Male Pancreatectomy - adverse effects Pancreatectomy - methods Pancreatic Neoplasms - surgery Postoperative Complications - classification Postoperative Complications - therapy Prognosis Risk Assessment Severity of Illness Index Surgery Treatment Outcome |
| title | Definition and classification of chyle leak after pancreatic operation: A consensus statement by the International Study Group on Pancreatic Surgery |
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