Definition and classification of chyle leak after pancreatic operation: A consensus statement by the International Study Group on Pancreatic Surgery

被引:239
|
作者
Besselink, Marc G. [1 ]
van Rijssen, L. Bengt [1 ]
Bassi, Claudio [2 ]
Dervenis, Christos [3 ]
Montorsi, Marco [4 ]
Adham, Mustapha [5 ]
Asbun, Horacio J. [6 ]
Bockhorn, Maximilian [7 ]
Strobel, Oliver [8 ]
Buechler, Markus W. [8 ]
Busch, Olivier R. [1 ]
Charnley, Richard M. [9 ]
Conlon, Kevin C. [10 ]
Fernandez-Cruz, Laureano [11 ]
Fingerhut, Abe [12 ,13 ]
Friess, Helmut [14 ]
Izbicki, Jakob R. [7 ]
Lillemoe, Keith D. [15 ,16 ]
Neoptolemos, John P. [17 ]
Sarr, Michael G. [18 ]
Shrikhande, Shailesh V. [19 ]
Sitarz, Robert [20 ]
Vollmer, Charles M. [21 ]
Yeo, Charles J. [22 ]
Hartwig, Werner [23 ]
Wolfgang, Christopher L. [24 ]
Gouma, Dirk J. [1 ]
机构
[1] Univ Amsterdam, Acad Med Ctr, Dept Surg, Amsterdam, Netherlands
[2] Univ Verona, Pancreas Inst, Dept Surg & Oncol, Verona, Italy
[3] Agia Olga Hosp, Dept Surg 1, Athens, Greece
[4] Humanitas Res Hosp & Univ, Dept Surg, Milan, Italy
[5] UCBL1, HCL, Hop Edouard Herriot, Dept HPB Surg, Lyon, France
[6] Mayo Clin, Dept Surg, Jacksonville, FL 32224 USA
[7] Univ Hosp Hamburg Eppendorf, Dept Gen Visceral & Thorac Surg, Hamburg, Germany
[8] Heidelberg Univ, Dept Gen Visceral & Transplantat Surg, Heidelberg, Germany
[9] Freeman Rd Hosp, Dept HPB & Transplant Surg, Newcastle Upon Tyne, Tyne & Wear, England
[10] Univ Dublin, Trinity Coll, Professorial Surg Unit, Dublin, Ireland
[11] Univ Barcelona, Hosp Clin Barcelona, Dept Surg, Barcelona, Spain
[12] Univ Athens, Hippokrateon Hosp, Dept Digest Surg 1, Athens, Greece
[13] Med Univ Graz, Dept Surg, Sect Surg Res, Graz, Austria
[14] Tech Univ Munich, Klinikum Rechts Isar, Dept Surg, Munich, Germany
[15] Massachusetts Gen Hosp, Dept Surg, Boston, MA 02114 USA
[16] Harvard Med Sch, Boston, MA USA
[17] Univ Liverpool, Dept Mol & Clin Canc Med, Liverpool, Merseyside, England
[18] Mayo Clin, Div Subspecialty Gen Surg, Rochester, MN USA
[19] Tata Mem Hosp, Dept GI & HPB Surg Oncol, Bombay, Maharashtra, India
[20] Med Univ Lublin, Dept Surg Oncol, Lublin, Poland
[21] Univ Penn, Penn Med, Dept Surg, Philadelphia, PA 19104 USA
[22] Thomas Jefferson Univ, Jefferson Pancreas Biliary & Related Canc Ctr, Dept Surg, Philadelphia, PA 19107 USA
[23] Univ Munich, Ludwig Maximilians Univ, Dept Gen Visceral & Transplantat Surg, Div Pancreat Surg, Munich, Germany
[24] Johns Hopkins Med, Dept Surg, Baltimore, MD USA
关键词
DUCTAL ADENOCARCINOMA; CISTERNA-CHYLI; RISK-FACTORS; ASCITES; PANCREATICODUODENECTOMY; MANAGEMENT; DIAGNOSIS; DISSECTION; RESECTIONS; DRAINAGE;
D O I
10.1016/j.surg.2016.06.058
中图分类号
R61 [外科手术学];
学科分类号
摘要
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.
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收藏
页码:365 / 372
页数:8
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