PP156-SUN CHYLE LEAKS AND UPPER GASTROINTESTINAL SURGERY

Abstract

Rationale: Recent advances in surgery, pioneered in Japan, involve increased lymph node harvest (lymphadenectomy) in patients with upper gastrointestinal cancer. An audit was undertaken to determine if the incidence of chyle leaks had increased after changes in surgical technique; whether the length of stay differed in patients with chyle leaks; and whether the type of nutrition affected recovery time. Methods: 113 patients who underwent surgery for upper gastrointestinal cancer (oesophagectomy, total gastrectomy with Roux-en-Y and subtotal gastrectomy with Roux-en-Y) at Imperial College Healthcare NHS Trust were identified. Dietetics records were reviewed to determine chyle leak occurrence and duration, length of stay, route and type of nutrition used, and clinical course including any change in the method of nutrition support. Four records were unavailable and three patients were excluded due to insufficient information, leaving 106 for analysis. Results: The rate of chyle leaks increased from 7.8% to 22% (p = 0.06) following increasingly radical lymphadenectomy, patients with chyle leaks experienced prolonged lengths of stay 16 vs 24 days (p = 0.003). 73% of patients with chyle leaks resolved with specialized oral (27%) or enteral feeding (72%); 27% required parenteral nutrition (TPN); of which one required surgery despite conservative measures. Those on oral intake had a reduced duration of chyle leak and hospital stay. 100% of patients fed enterally received MCT feed. Conclusion: The incidence of chyle leaks has increased with increasingly radical surgery as hypothesized. Patients with chyle leaks stay longer as the leak must be resolved before building up to a normal diet and surveillance is required. The majority of patients’ leaks resolve with specialized oral or enteral nutritional measures; a very low fat or MCT diet, as previously reported. Nevertheless a minority of patients still required TPN to enable the leak to heal.