OBJECTIVE To identify the risk factors, manifestations, and clinical implications of chyle leak (CL) after pancreatic surgery, and to reappraise the International Study Group for Pancreatic Surgery (ISGPS) definition and classification of CL. SUMMARY BACKGROUND DATA The risk factors, clinical scenarios, and management of CL after pancreatic surgery remain controversial. METHODS Data from patients who underwent pancreatic surgery between January 2019 and July 2023 were retrieved from an institutional database. The risk factors, manifestations, and clinical impact of CL were analyzed. RESULTS Of the 1,063 patients enrolled, 117 (11.0%) developed CL, including 33 grade A and 84 grade B. Minimally invasive approach (OR: 3.087, 95% CI: 1.790-5.236, P<0.001) and maximum daily drainage volume (OR: 1.004, 95% CI: 1.003-1.005, P<0.001) were identified as independent risk factors for CL. Three hundred ninety-six patients (37.3%) presented with triglyceride (TG)-rich (≥1.2 mmol/L) drainage without a milky-colored appearance. The length of postoperative stay for patients with large-volume (≥300 mL/day), TG-rich but non-milky drainage (n=72) was significantly longer than that for patients with small-volume (<300 mL/day) (n=324, median, 19 days vs. 14 days, P<0.001), and it was comparable to that for patients with large-volume (≥300 mL/day), TG-rich, and milky drainage (n=74, median, 19 days vs. 22 days, P=0.126). CONCLUSION Minimally invasive approach and daily maximum drainage volume were independent risk factors for CL in this cohort. Post-pancreatectomy patients with large-volume, TG-rich but non-milky drainage should be treated like clinically relevant CL.

中文翻译：

---

乳糜瘘的危险因素、表现和影响 - 胰腺手术后：乳糜瘘的体积可能超过乳白色的引流物。


目的 确定胰腺手术后乳糜漏 （CL） 的危险因素、表现和临床意义，并重新评估国际胰腺外科研究组 （ISGPS） 对 CL 的定义和分类。摘要 背景数据 胰腺手术后 CL 的危险因素、临床情况和管理仍存在争议。方法 从机构数据库中检索 2019 年 1 月至 2023 年 7 月期间接受胰腺手术的患者的数据。分析 CL 的危险因素、表现和临床影响。结果 在入组的 1,063 例患者中，117 例 （11.0%） 发生 CL，包括 33 例 A 级和 84 例 B 级。微创入路 （OR： 3.087,95% CI： 1.790-5.236，P<0.001） 和最大每日引流量 （OR： 1.004,95% CI： 1.003-1.005，P<0.001） 被确定为 CL 的独立危险因素。396 例患者 （37.3%） 表现为富含甘油三酯 （TG） （≥1.2 mmol/L） 的引流物，无乳白色外观。大容量 （≥300 mL/d）、富含 TG 但非乳白色引流的患者 （n=72） 的术后住院时间显著长于小容量 （<300 mL/d） 患者 （n=324，中位数，19 天 vs. 14 天，P<0.001），与大容量 （≥300 mL/d）、富含 TG 且乳白色引流的患者相当 （n=74， 中位数为 19 天 vs. 22 天，P = 0.126）。结论 微创入路和每日最大引流量是该队列中 CL 的独立危险因素。胰腺切除术后有大容量、富含 TG 但非乳白色引流物的患者应像临床相关的 CL 一样治疗。