Chyle Leak After Pancreatoduodenectomy: Clinical Impact and Risk Factors in a Nationwide Analysis
The aim of this study was to assess the clinical impact and risk factors of chyle leak (CL). 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 ri...
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| Veröffentlicht in: | Annals of surgery 2023-06, Vol.277 (6), p.e1299-e1305 |
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| creator | Augustinus, Simone Latenstein, Anouk E.J. Bonsing, Bert A. Busch, Olivier R. Groot Koerkamp, Bas de Hingh, Ignace H.J.T. de Meijer, Vincent E. Molenaar, I.Q. van Santvoort, Hjalmar C. de Vos-Geelen, Judith van Eijck, Casper H. Besselink, Marc G. |
| description | The aim of this study was to assess the clinical impact and risk factors of chyle leak (CL).
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.
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.
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 |
| doi_str_mv | 10.1097/SLA.0000000000005449 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10174101</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2685039702</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3576-a68a3302bed855891876f03ad02eee6a5f55300910d34fe011a4edcb7f9098263</originalsourceid><addsrcrecordid>eNpdkduO0zAQQCMEYsvCHyDkR16y2PElNi-oqnZhpQoQl2drmkyoqWMXO6Hq32PUsixYskf2zByPdKrqOaNXjJr21ef18oreW1II86BaMNnomjFBH1aL8sprYXhzUT3J-TulTGjaPq4uuGy1UlQtKlhtjx7JGmFHlsOEiXyE0CWEKfZz7DFgN8Xx-JqsvAuuA09uxz10E4HQk08u78hNucWUiQsEyHuYXAwH1yNZBvDH7PLT6tEAPuOzc7ysvt5cf1m9q9cf3t6uluu6K9OoGpQGzmmzwV5LqQ3TrRooh542iKhADlJySg2jPRcDUsZAYN9t2sFQoxvFL6s3J-5-3owlg2FK4O0-uRHS0UZw9t9McFv7Lf60jLJWlKMQXp4JKf6YMU92dLlD7yFgnLNtlJaUm5Y2pVScSrsUc0443P3DqP2txxY99n89pe3F_Rnvmv74-Ms9RF9k5J2fD5jsFsFP2xNPSV0bc6bWZQvFfwGYeprm</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2685039702</pqid></control><display><type>article</type><title>Chyle Leak After Pancreatoduodenectomy: Clinical Impact and Risk Factors in a Nationwide Analysis</title><source>MEDLINE</source><source>PubMed Central</source><source>Journals@Ovid Complete</source><creator>Augustinus, Simone ; Latenstein, Anouk E.J. ; Bonsing, Bert A. ; Busch, Olivier R. ; Groot Koerkamp, Bas ; de Hingh, Ignace H.J.T. ; de Meijer, Vincent E. ; Molenaar, I.Q. ; van Santvoort, Hjalmar C. ; de Vos-Geelen, Judith ; van Eijck, Casper H. ; Besselink, Marc G.</creator><creatorcontrib>Augustinus, Simone ; Latenstein, Anouk E.J. ; Bonsing, Bert A. ; Busch, Olivier R. ; Groot Koerkamp, Bas ; de Hingh, Ignace H.J.T. ; de Meijer, Vincent E. ; Molenaar, I.Q. ; van Santvoort, Hjalmar C. ; de Vos-Geelen, Judith ; van Eijck, Casper H. ; Besselink, Marc G. ; Dutch Pancreatic Cancer Group ; on behalf of the Dutch Pancreatic Cancer Group</creatorcontrib><description>The aim of this study was to assess the clinical impact and risk factors of chyle leak (CL).
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.
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.
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.
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.</description><identifier>ISSN: 0003-4932</identifier><identifier>EISSN: 1528-1140</identifier><identifier>DOI: 10.1097/SLA.0000000000005449</identifier><identifier>PMID: 35786606</identifier><language>eng</language><publisher>United States: Lippincott Williams & Wilkins</publisher><subject>Chyle ; Humans ; Original ; Pancreatic Neoplasms - surgery ; Pancreaticoduodenectomy - adverse effects ; Pancreaticoduodenectomy - methods ; Postoperative Complications - etiology ; Risk Factors</subject><ispartof>Annals of surgery, 2023-06, Vol.277 (6), p.e1299-e1305</ispartof><rights>Lippincott Williams & Wilkins</rights><rights>Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.</rights><rights>Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. 2023</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3576-a68a3302bed855891876f03ad02eee6a5f55300910d34fe011a4edcb7f9098263</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10174101/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10174101/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35786606$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Augustinus, Simone</creatorcontrib><creatorcontrib>Latenstein, Anouk E.J.</creatorcontrib><creatorcontrib>Bonsing, Bert A.</creatorcontrib><creatorcontrib>Busch, Olivier R.</creatorcontrib><creatorcontrib>Groot Koerkamp, Bas</creatorcontrib><creatorcontrib>de Hingh, Ignace H.J.T.</creatorcontrib><creatorcontrib>de Meijer, Vincent E.</creatorcontrib><creatorcontrib>Molenaar, I.Q.</creatorcontrib><creatorcontrib>van Santvoort, Hjalmar C.</creatorcontrib><creatorcontrib>de Vos-Geelen, Judith</creatorcontrib><creatorcontrib>van Eijck, Casper H.</creatorcontrib><creatorcontrib>Besselink, Marc G.</creatorcontrib><creatorcontrib>Dutch Pancreatic Cancer Group</creatorcontrib><creatorcontrib>on behalf of the Dutch Pancreatic Cancer Group</creatorcontrib><title>Chyle Leak After Pancreatoduodenectomy: Clinical Impact and Risk Factors in a Nationwide Analysis</title><title>Annals of surgery</title><addtitle>Ann Surg</addtitle><description>The aim of this study was to assess the clinical impact and risk factors of chyle leak (CL).
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.
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.
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.
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.</description><subject>Chyle</subject><subject>Humans</subject><subject>Original</subject><subject>Pancreatic Neoplasms - surgery</subject><subject>Pancreaticoduodenectomy - adverse effects</subject><subject>Pancreaticoduodenectomy - methods</subject><subject>Postoperative Complications - etiology</subject><subject>Risk Factors</subject><issn>0003-4932</issn><issn>1528-1140</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkduO0zAQQCMEYsvCHyDkR16y2PElNi-oqnZhpQoQl2drmkyoqWMXO6Hq32PUsixYskf2zByPdKrqOaNXjJr21ef18oreW1II86BaMNnomjFBH1aL8sprYXhzUT3J-TulTGjaPq4uuGy1UlQtKlhtjx7JGmFHlsOEiXyE0CWEKfZz7DFgN8Xx-JqsvAuuA09uxz10E4HQk08u78hNucWUiQsEyHuYXAwH1yNZBvDH7PLT6tEAPuOzc7ysvt5cf1m9q9cf3t6uluu6K9OoGpQGzmmzwV5LqQ3TrRooh542iKhADlJySg2jPRcDUsZAYN9t2sFQoxvFL6s3J-5-3owlg2FK4O0-uRHS0UZw9t9McFv7Lf60jLJWlKMQXp4JKf6YMU92dLlD7yFgnLNtlJaUm5Y2pVScSrsUc0443P3DqP2txxY99n89pe3F_Rnvmv74-Ms9RF9k5J2fD5jsFsFP2xNPSV0bc6bWZQvFfwGYeprm</recordid><startdate>20230601</startdate><enddate>20230601</enddate><creator>Augustinus, Simone</creator><creator>Latenstein, Anouk E.J.</creator><creator>Bonsing, Bert A.</creator><creator>Busch, Olivier R.</creator><creator>Groot Koerkamp, Bas</creator><creator>de Hingh, Ignace H.J.T.</creator><creator>de Meijer, Vincent E.</creator><creator>Molenaar, I.Q.</creator><creator>van Santvoort, Hjalmar C.</creator><creator>de Vos-Geelen, Judith</creator><creator>van Eijck, Casper H.</creator><creator>Besselink, Marc G.</creator><general>Lippincott Williams & Wilkins</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20230601</creationdate><title>Chyle Leak After Pancreatoduodenectomy: Clinical Impact and Risk Factors in a Nationwide Analysis</title><author>Augustinus, Simone ; Latenstein, Anouk E.J. ; Bonsing, Bert A. ; Busch, Olivier R. ; Groot Koerkamp, Bas ; de Hingh, Ignace H.J.T. ; de Meijer, Vincent E. ; Molenaar, I.Q. ; van Santvoort, Hjalmar C. ; de Vos-Geelen, Judith ; van Eijck, Casper H. ; Besselink, Marc G.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3576-a68a3302bed855891876f03ad02eee6a5f55300910d34fe011a4edcb7f9098263</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Chyle</topic><topic>Humans</topic><topic>Original</topic><topic>Pancreatic Neoplasms - surgery</topic><topic>Pancreaticoduodenectomy - adverse effects</topic><topic>Pancreaticoduodenectomy - methods</topic><topic>Postoperative Complications - etiology</topic><topic>Risk Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Augustinus, Simone</creatorcontrib><creatorcontrib>Latenstein, Anouk E.J.</creatorcontrib><creatorcontrib>Bonsing, Bert A.</creatorcontrib><creatorcontrib>Busch, Olivier R.</creatorcontrib><creatorcontrib>Groot Koerkamp, Bas</creatorcontrib><creatorcontrib>de Hingh, Ignace H.J.T.</creatorcontrib><creatorcontrib>de Meijer, Vincent E.</creatorcontrib><creatorcontrib>Molenaar, I.Q.</creatorcontrib><creatorcontrib>van Santvoort, Hjalmar C.</creatorcontrib><creatorcontrib>de Vos-Geelen, Judith</creatorcontrib><creatorcontrib>van Eijck, Casper H.</creatorcontrib><creatorcontrib>Besselink, Marc G.</creatorcontrib><creatorcontrib>Dutch Pancreatic Cancer Group</creatorcontrib><creatorcontrib>on behalf of the Dutch Pancreatic Cancer Group</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><collection>PubMed Central (Full Participant titles)</collection><jtitle>Annals of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Augustinus, Simone</au><au>Latenstein, Anouk E.J.</au><au>Bonsing, Bert A.</au><au>Busch, Olivier R.</au><au>Groot Koerkamp, Bas</au><au>de Hingh, Ignace H.J.T.</au><au>de Meijer, Vincent E.</au><au>Molenaar, I.Q.</au><au>van Santvoort, Hjalmar C.</au><au>de Vos-Geelen, Judith</au><au>van Eijck, Casper H.</au><au>Besselink, Marc G.</au><aucorp>Dutch Pancreatic Cancer Group</aucorp><aucorp>on behalf of the Dutch Pancreatic Cancer Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Chyle Leak After Pancreatoduodenectomy: Clinical Impact and Risk Factors in a Nationwide Analysis</atitle><jtitle>Annals of surgery</jtitle><addtitle>Ann Surg</addtitle><date>2023-06-01</date><risdate>2023</risdate><volume>277</volume><issue>6</issue><spage>e1299</spage><epage>e1305</epage><pages>e1299-e1305</pages><issn>0003-4932</issn><eissn>1528-1140</eissn><abstract>The aim of this study was to assess the clinical impact and risk factors of chyle leak (CL).
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.
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.
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.
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.</abstract><cop>United States</cop><pub>Lippincott Williams & Wilkins</pub><pmid>35786606</pmid><doi>10.1097/SLA.0000000000005449</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Chyle Humans Original Pancreatic Neoplasms - surgery Pancreaticoduodenectomy - adverse effects Pancreaticoduodenectomy - methods Postoperative Complications - etiology Risk Factors |
| title | Chyle Leak After Pancreatoduodenectomy: Clinical Impact and Risk Factors in a Nationwide Analysis |
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