Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands.
Cancer Center Amsterdam, Amsterdam, The Netherlands.
Ann Surg. 2023 Jun 1;277(6):e1299-e1305. doi: 10.1097/SLA.0000000000005449. Epub 2022 Jul 4.
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.
本研究旨在评估乳糜漏（CL）的临床影响和危险因素。
2017 年，国际胰腺外科研究组（ISGPS）发布了 CL 的共识定义。缺乏验证该定义的多中心系列研究，并且之前研究 CL 危险因素的研究使用了不同的定义且结果存在异质性。
这是一项观察性队列研究，纳入了荷兰全国胰腺癌审计（2017-2019 年）所有 19 个中心行胰十二指肠切除术的所有连续患者。主要终点是 CL（ISGPS 分级 B/C）。进行多变量逻辑回归分析。
共纳入 2159 例行胰十二指肠切除术的患者。CL 发生率为 7.0%（n=152），其中 6.9%（n=150）为 B 级，0.1%（n=2）为 C 级。CL 与住院时间延长独立相关[比值比（OR）=2.84，95%置信区间（CI）：1.85-4.36，P<0.001]，但与死亡率无关（OR=0.3，95% CI：0.0-2.3，P=0.244）。多变量分析中，CL 的独立预测因素为血管切除（OR=2.1，95% CI：1.4-3.2，P<0.001）和开放性手术（OR=3.5，95% CI：1.7-7.2，P=0.001）。切除的淋巴结数量和腹主动脉旁淋巴结采样在多变量分析中未被确定为预测因素。
在这项全国性分析中，胰十二指肠切除术后 ISGPS 分级 B/C CL 的发生率为 7.0%。尽管 CL 与住院时间延长相关，但在绝大多数（>98%）患者中，其临床影响相对较小。血管切除和开放性手术是 CL 的预测因素。
