Chyle Leak Research Articles

Surgical Complications in Papillary Thyroid Cancer Patients with Cervical Lymph Node Metastases.

The reported complication rates of neck dissection are not specific patients with papillary thyroid cancer` with metastatic lymph nodes. This study aimed to describe the complication profile of neck dissection and the effect of concurrent lateral neck dissection on complication rates. This single-center prospective cohort study analyzed the data of 52 patients who underwent a total thyroidectomy and therapeutic lymph node dissection between March 2021 and March 2023. The clinicopathologic characteristics of patients and surgical complications were analyzed. The transient recurrent laryngeal nerve palsy (RLNP) and hypoparathyroidism rates were 55.8% and 51.9%, respectively. The chyle leakage rate was 5.8%. Tracheostomy was performed on 1 patient (1.9%). Patients with transient RLNP had more retrieved lymph nodes than patients without RLNP (5.5 ± 2.7 vs 3.9 ± 1.5, P = .013). The rates of transient RLNP and hypoparathyroidism were higher in the total thyroidectomy with central and lateral neck dissection group than the total thyroidectomy with central neck dissection group (62.2% vs 14.3%, P = .035 and 57.8% vs 14.3%, P = .046). Multivariate analysis showed that the increased number of retrieved lymph nodes in the central compartment and the addition of lateral neck dissection were independent risk factors for transient RLNP, with odds ratio (OR) (95% confidence interval) of 0.72 (0.53-0.98) and 9.42 (1.02-87.34). The rates of transient RLNP and hypoparathyroidism after lymph node dissection in patients with papillary thyroid cancer with metastatic lymph nodes were high, and a greater number of retrieved lymph nodes in the central neck and the addition of lateral neck dissection were predictors for transient RLNP. These data may be used to discuss preoperatively with patients and make surgeons more cautious and meticulous during surgery to minimize complications.

Thoracic Duct Embolization for Treatment of Chyle Leakage After Thyroidectomy and Neck Dissection.

This study aimed to evaluate the safety and efficacy of intranodal lymphangiography and thoracic duct embolization (TDE) for chyle leakage (CL) after thyroid surgery. Fourteen patients who underwent intranodal lymphangiography and TDE for CL after thyroid surgery were included in this retrospective study. Among the 14 patients, 13 underwent bilateral total thyroidectomy with neck dissection (central compartment neck dissection [CCND], n = 13; left modified radical neck dissection (MRND), n = 11; bilateral MRND, n = 2), and one patient underwent left hemithyroidectomy with CCND. Ten patients (76.9%) had high-output CL (> 500 mL/d). Before the procedure, surgical intervention was attempted in three patients (thoracic duct ligation, n = 1; lymphatic leakage site ligation, n = 2). Lymphangiographic findings, technical and clinical successes, and complications were analyzed. Technical success was defined as the successful embolization of the thoracic duct after access to the lymphatic duct via the transabdominal route. Clinical success was defined as the resolution of CL or surgical drain removal. On lymphangiography, ethiodized oil leakage near the surgical bed was identified in 12 of 14 patients (85.7%). The technical success rate of TDE was 78.6% (11/14). Transabdominal antegrade access was not feasible due to the inability to visualize the identifiable cisterna chyli or a prominent lumbar lymphatic duct. Among patients who underwent a technically successful TDE, the clinical success rate was 90.1% (10/11). The median time from the procedure to drain removal was 3 days (with a range of 1-13 days) for the 13 patients who underwent surgical drainage. No CL recurrence was observed during the follow-up period (ranging from 2-44 months; median, 8 months). There were no complications, except for one case of chylothorax that developed after TDE. TDE appears to be a safe and effective minimally invasive treatment option for CL after thyroid surgery, with acceptable technical and clinical success rates.

Successful Management of Chyle Leakage Using Thoracic Duct Embolization: A Case Report

Successful Management of Chyle Leakage Using Thoracic Duct Embolization: A Case Report

Prevention, incidence, and risk factors of chyle leak after radical nephrectomy and thrombectomy.

To define the incidence and risk factors of chyle leak (CL) after radical nephrectomy and thrombectomy and to determine the impact of chyle leak on oncological outcomes. A total of 445 patients who underwent radical nephrectomy and thrombectomy between January 2014 and January 2023 were included. CL is defined as the drainage of chyle with a triglyceride level greater than 110 mg/dL after oral intake or enteral nutrition. Multivariate logistic regression analysis was performed to identify the risk factors of postoperative (CL). The Kaplan-Meier curves were used to compare overall survival and cancer-specific survival. 44 patients (9.9%) were diagnosed as (CL). All patients developed CL within 6 days after the operation with a median time of 3 days. In multivariate logistic regression analysis, Mayo grade and side were independent patient-related risk factors. In addition, operation approach, operation time, and number of lymph nodes harvested were independent surgery-related risk factors. Between the CL group and the non-CL group, neither overall survival nor cancer-specific survival showed statistical differences. Based on this retrospective study of renal cell carcinoma and tumor thrombus patients in our center, we found that the risk factors were Mayo grade, side, operation approach,operation time, and number of lymph nodes harvested, and the occurrence of CL significantly prolonged hospital stay, but had no effect on long-term oncological outcomes.

Updates on the pathophysiology and therapies of chylous pleural effusion: A narrative review

Chylous pleural effusion (CPE) is a milky pleural fluid that contains high levels of proteins, cholesterol, triglycerides, or chylomicrons. The main cause of CPE is disruption of the thoracic duct caused by traumatic or non-traumatic causes. High triglyceride, cholesterol, and/or chylomicron levels confirm the diagnosis. Recognizing the chyle leak site and underlying etiology is critical to the management of this clinical condition. There is no specific consensus on chylothorax treatment. However, a multidisciplinary (medical, surgical, and oncological) team approach is recommended.

The impact of lymphangiograpy on chyle leakage treatment duration after pancreatic surgery.

Chyle leakage (CL) is a common complication in pancreatic surgery. Lymphangiography is a therapeutic option for CL in cases of conservative treatment failure. This study investigated the effect of lymphangiography on the healing time of CL. We retrospectively evaluated 283 patients who underwent pancreatic resection between January 2016 and June 2022. The risk factors for CL and the treatment period were evaluated according to whether or not lymphangiography was performed. Of the 29 patients (10.2%) that had CL, lymphangiography was performed in 6. Malignant disease, the number of harvested lymph nodes, and drain fluid volume on postoperative day 2 were identified as independent risk factors for CL. Lymphangiography was associated with the cumulative healing rate of CL, and patients who underwent lymphangiography had a significantly shorter treatment period. No lymphangiography-related adverse events were observed. Lymphangiography is a feasible and safe treatment option for CL. The CL treatment period after pancreatic surgery was significantly shorter in patients who underwent lymphangiography than in those who did not. Our results suggest that lymphangiography may contribute to early improvement of persistent CL.

Treatment of Postoperative Neck Dissection Cervical Lymphocele With Percutaneous Bleomycin Sclerotherapy.

Lymphatic leak after lymph node dissection is a rare but well-known surgical complication that is often treated with conservative management and ultimately reoperation. The purpose of this report is to offer an alternative treatment for chyle leak that avoids hospitalization and subsequent surgery. Sclerotherapy has been used to treat lymphatic leaks in the past and has been shown to be safe and effective. This report presents a patient with a known cervical lymphocele who was followed through multiple sclerotherapy appointments until resolution of the lymphocele.

Usefulness of preoperative ice cream consumption and novel postoperative drainage management in patients undergoing left-sided neck dissection for thyroid cancer: a nonrandomized prospective study

PurposeThis study investigated the effects of ice cream consumption on chyle leakage after left lateral neck dissection in patients with thyroid cancer.MethodsA total of 491 patients with thyroid cancer underwent left lateral neck dissection with identification of the thoracic duct following ice cream consumption. Before closing the wound, the anesthesiologist increased the intrathoracic pressure to observe chyle leakage. If chyle leakage occurred postoperatively, the drain was removed using the drain negative pressure release test.ResultsPostoperative chyle leakage was observed in 18 of the 491 patients who underwent left lateral neck dissection. We treated 17 patients conservatively and 1 patient surgically. Drains were removed within five days in all patients. After the drain negative pressure release test had been performed in eight patients, the drainage volume significantly decreased from an average of 175 ml to 31 ml per day. The average number of days until the removal of the drainage tube was 3.2 days. No perioperative complications were associated with ice cream consumption.ConclusionsIn left lateral neck dissection for thyroid cancer, performing surgery following ice cream consumption does not completely prevent chyle leakage; however, early drain removal is possible because there is only mild leakage.

Management of Chyle Leakage after Thyroid Cancer Surgery

Management of Chyle Leakage after Thyroid Cancer Surgery

Complete mesocolic excision for right colon cancer: Is D3 lymphadenectomy necessary?

Although complete mesocolic excision (CME) for colon cancer is oncologically sound, to date, there has been no consensus on the extent of lymphadenectomy in radical right colectomy. This study essentially compared the perioperative and survival outcomes of CME with two templates of lymphadenectomy for right colon cancer. This was a propensity matched, retrospective analysis of a single centre, prospectively maintained database of all patients undergoing elective right colectomy for nonmetastatic, biopsy-proven adenocarcinoma from November 2013 to October 2018. CME + D3 was adopted selectively, documented prospectively, and compared with patients undergoing CME + central vascular ligation (CVL). The only technical difference between the groups was the excision of the surgical trunk of Gillot in the CME + D3 group. Postoperative, long-term outcomes and patterns of recurrence were compared between the groups. Of the 244 eligible patients, 88 (36.1%) and 156 (63.9%) underwent CME + D3 and CME + CVL, respectively. Matched groups (72 [CME + D3] vs. 108 [CME + CVL]) showed no difference in histology, tumour grade, postoperative complications, mortality, and hospital stay. CME + D3 was preferentially performed laparoscopically (35.2% vs. 9%), was associated with lower blood loss (215 mL vs. 297 mL, p = 0.001), higher nodal yield (31 vs. 25 nodes, p = 0.003) and a higher incidence of chyle leak (4 vs. 0, p = 0.013). At a median follow-up of more than 57 months, there was no significant difference in local recurrence, disease-free or overall survival. In this retrospective study, lymphadenectomy along the superior mesenteric vein, as a component of CME for right colon cancer, offered a higher nodal yield with no improvement in oncological outcome. Dissection of the SMV, over and above a D2 dissection, could therefore be restricted to specialized colorectal units until further studies establish the incremental oncological benefit of this extended lymphadenectomy or define a patient group in whom it is beneficial.

Pancreatic resection for metastasis from renal cell carcinoma: A single institution experience and meta-analysis of survival outcomes

AimsTo evaluate short-term clinical and long-term survival outcomes of pancreatic resection for pancreatic metastasis from renal cell carcinoma (RCC). MethodsA retrospective evaluation of patients undergoing pancreatic resection for metastasis from RCC over a 12-years period was conducted. Furthermore, a systematic search of electronic data sources and bibliographic reference lists were conducted to identify studies investigating the same clinical question. Short-term clinical and long-term survival outcomes were evaluated. Kaplan-Meier survival plots were constructed for survival outcomes. Cox-proportional regression analysis was performed to determine factors associated with survival. Finally, meta-analysis of survival outcomes was conducted using random-effects modelling. ResultsEighteen patients underwent pancreatic resections for RCC pancreatic metastasis within the study period. The mean age of the included patients was 63.8 ± 8.0 years. There were 10(55.6 %) male and 8(44.4 %) female patients. Pancreatectomy was associated with 4(25.0 %) Clavien–Dindo (C-D) I, 5(31.3 %) C-D II, and 7(43.7 %) C-D III complications, 7(38.8 %) pancreatic fistula, 3(16.7 %) post-pancreatectomy acute pancreatitis, 1(5.6 %) delayed gastric emptying, and 1(5.6 %) chyle leak. The mean length of hospital stay was 18 ± 16.3 days. The median survival was 64 months (95 % CI 60–78). The 3-and 5-year disease-free survival rates were 83.3 % and 55.5 %, respectively. The 3-and 5-year survival rates were 100 % and 55.6 %, respectively. The pooled analyses of 553 patients demonstrated 3-and 5-year survival rates of 77.6 % and 60.7 %, respectively. ConclusionsPancreatectomy for RCC metastasis is associated with acceptable short-term clinical and promising long-term survival outcomes. Considering the rarity of the entity, escalation of level of evidence in this context is challenging.

OGC O09 Fluorescence lymphography using indocyanine green in the prevention of chyle leakage after minimally invasive esophagectomy

Abstract Background For oncological reasons, the thoracic duct is resected during esophagectomy for cancer. Its anatomy and vulnerability render it prone to injury and mainly side branches and collaterals are often hard to visualize. Chyle leakage is one of the most challenging complications in esophagectomy, with an incidence of 14-21%. The clinical implications for patients are prolonged thoracic drainage and hospital admission, additional reinterventions, unpleasant dietary restrictions, and decreased long-term survival. Fluorescence lymphography using indocyanine green (ICG) can accurately visualize the thoracic duct and collaterals, which may possibly reduce the incidence of chyle leakage and intra-operative detected chyle leakage can be treated directly. Methods A prospective observational cohort study will be performed. Patients aged over 18 years with resectable (cT1-4a, N0-3, M0) esophageal carcinoma undergoing a minimally invasive esophagectomy will be included. The primary endpoint of the study is postoperative chyle leakage. Secondary endpoints are overall morbidity and mortality, nature of dietary restrictions, reinterventions, hospital costs, 2 year survival rate and quality of life. Twenty-five milligram of ICG is dissolved in 10 ml of sterile water, obtaining a solution of 2.5 mg ICG per mL. In the McKeown esophagectomy, before the thoracic phase, the surgeon administers a bilateral bolus of 2 mL ultrasound-guided into inguinal lymph nodes. In an Ivor Lewis esophagectomy, 2mL of reconstituted ICG will be injected into the small bowel mesenteric root just under the peritoneum of the mesentery, at the level where the jejunostomy is placed. Additionally, 50 mL of cream is enterally administered through the just established feeding jejunostomy. Subsequently, the operating area is inspected for chyle leakage with fluorescence lymphography after thoracic duct ligation and just before terminating the procedure. Results We aim to include 50 patients to assess the feasibility of fluorescent lymphography using ICG and enteral cream to prevent chyle leakage after minimally esophagectomy. Inclusion is ongoing. At this time 39 of 50 patients are included. Results will be expected before the congress. Conclusions It is hypothesized that as a result of this technique the patients will benefit from lower incidence of postoperative chyle leakage, shorter thoracic drainage, reduced hospital admission, reduced dietary restriction, less re-interventions, and improved overall survival.

OGC P24 The impact of early enteral feed composition on the rate of chyle leak post-oesophagectomy

Abstract Background Patients undergoing oesophagectomy are at significant risk of malnutrition and benefit from peri-operative enteral feeding. Chyle leak presents in up to 20% of patients undergoing an oesophageal resection and is associated with immunosuppression, malnutrition and increased complications. Early enteral feeding can increase the rate of chyle leak in these patients. Enteral feed with a high percentage of fat as medium chain triglycerides (MCT) is more easily absorbed and can reduce chyle production. We evaluated the impact of early enteral MCT-rich feed on the prevalence and severity of chyle leak post-oesophagectomy. Secondary outcomes include length stay, and post-operative weight change. Methods Retrospective review of records from consecutive patients undergoing oesophagectomy at a single tertiary centre between January 2015 and December 2022. Following specialist dietician input, patients received enteral feed on post-operative day 1 – 5 with Nutrison Protein Plus Energy (standard; 5.8% total fat, 0.9% (MCT)) (2015-June 2021) or Nutrison Peptisorb Plus HEHP (HEHP; 5% total fat and 3% MCT) enteral feed (June 2021 to Dec 2022). All patients transitioned to standard feed on post-operative day 6 onwards and were discharged on IDDSI level 4 diet and supplemental jejunal feeding. Patients who did not commence early enteral feeding were excluded from analysis. Results A total of 329 patients were included. Patients who received early enteral HEHP feed had fewer chyle leaks (5/52; 9.6%) compared to patients who received early enteral standard feed (68/277; 24.5% p=0.017). The proportion of ECCG grade I and II leaks was similar between groups. No patients required surgical intervention for a chyle leak during the study period. The HEHP group had a shorter critical care (p<0.001) and total length of hospital stay (p=0.011). Weight change from pre-operative baseline was equivalent in both groups at 6 weeks (standard; -4.5%, HEHP; -2.3%, P=0.066) and 3 months (standard; -5.6%, HEHP -4.0%, P=0.400). Conclusions In the context of routine jejunostomy use and early enteral feeding post-oesophagectomy, HEHP feed on post-operative day 1- day 5 was associated with a significantly lower chyle leak rate with corresponding shorter length of stay compared to standard feed. No difference was noted in post-operative weight change between groups which was relatively well preserved up to 3 months post-operatively.

Anticoagulation prophylaxis patterns following retroperitoneal lymph node dissection for testis cancer

IntroductionRetroperitoneal lymph node dissection (RPLND) is the standard of care for testicular cancer in various disease settings. Deep vein thrombosis (DVT) complications have been reported to occur in <1% of primary RPLND cases and up to 3% of postchemotherapy (PC-RPLND) cases. While prophylactic anticoagulation (AC) has been well-documented to reduce DVT rates in patients undergoing surgery in general, the benefit of prophylactic AC in RPLND has not been assessed. In this retrospective cohort study, we seek to address this unmet need by evaluating the rates and associated risk factors of DVT and pulmonary embolism (PE) with a national and institutional database, assess the changing patterns in DVT prophylaxis with postoperative AC following RPLND, and quantify the potential benefit of prophylactic AC in patients who have undergone RPLND using a risk-stratified approach. MethodsThe National Surgical Quality Improvement Program (NSQIP) database was queried for patients who underwent RPLND during the 10-year period from 2011 to 2021. An institutional database was queried for all patients undergoing RPLND from 2013 to 2022. Patient characteristics and operative outcomes were compared between the NSQIP and the institutional database. The institutional database was stratified by prior oncologic treatment (i.e., primary RPLND vs. PC-RPLND) and outcomes were compared. Postoperative AC rate was determined and trended by year. The use of postoperative AC and PE events were stratified by clinical stage. The absolute risk reduction (ARR) of AC prophylaxis on PE events and the number needed to treat (NNT) with AC prophylaxis to prevent a single PE event was determined. ResultsIn total, the NSQIP database query resulted in 779 patients and our institutional database query resulted in 188 patients. The rate of DVT and PE was 1.2% and 0.5% vs. 2.1% and 1.6% in the NSQIP and institutional cohort, respectively. The rate of postoperative AC following RPLND in patients from the institutional database increased from 5% in 2013 to 43% in 2022 (P = 0.01). There were no statistically significant differences in complication rates, including bleeding events, chyle leaks, or hospital readmissions amongst patients who were prescribed AC at discharge and those who were not. No stage I patients developed PEs and no stage I patients were prescribed AC. The ARR for AC prophylaxis for development of PE was found to be 0.023 for the clinical stage II and stage III cohorts. The NNT to prevent a single PE with AC was 44 and 43 for the stage II and stage III cohorts, respectively. ConclusionsAC appears beneficial with minimal risk of harm after RPLND, especially in patients with higher risk of developing DVT/PE, highlighting the safety and efficacy of this regimen. There was a significant increase in the rate of AC prophylaxis at discharge amongst patients undergoing RPLND in the institutional database from 2013 to 2022. A risk-stratified protocol of postoperative AC following RPLND appears reasonable, and further prospective trials are warranted to formally confirm this recommendation.

HPB P02 Leiomyosarcoma of IVC

Abstract Background Leiomyosarcoma of the inferior vena cava (IVC) is a very rare entity with poor 5-year prognosis. Less than 400 cases have been reported in literature. The extent of mass forming lesions is quite progressed upon discovery and multiorgan resection is often required. Here we present our 5year experience and surgical management of this malignancy. Methods From 2000 - 2023, 7 cases with IVC Leiomyosarcoma were treated in our institution. The median patient age was 59 years old with female gender predominance involvement. All patients presented with vague abdominal symptoms prompted imaging studies discovering the tumour, or the latter was an incidental finding of a retroperitoneal mass involving the IVC and adjacent organs (liver, kidney, duodenum). Only 4 patients (56%) had preoperative CT guided biopsy confirming the diagnosis and 3 cases were confirmed from post operative histology. Results All cases were reviewed in our multidisciplinary meeting and 4 patients (56 %) underwent surgical resection with caval replacement using a graft apart from one case which underwent IVC ligation. Liver resection was required after portal flow manipulation in two cases. Postoperative complications were ascites and chyle leak which were managed conservatively. Resection margins were negative (R0) to all cases. One case recurred and underwent further liver resections. Chemotherapy was offered only to unresectable cases (42%). From resected patients three of them (42%) are still alive with longest follow up of 4.5years post-resection and one died after multiple resections. Conclusions IVC Leiomyosarcoma is an aggressive malignancy and requires major surgery upon diagnosis. Surgery is the gold standard treatment since unrespectability upon diagnosis has poor prognosis. Due to rarity of the disease, large studies are difficult to be conducted.

OGC P45 Complications in patients undergoing robotic-assisted oesophagectomy at a single centre

Abstract Background Robotic-assisted oesophagectomy is increasingly being utilised in the management of oesophageal cancer. The implementation into practice comes with an inevitable learning curve and it is important to ensure that this does not occur at the expense of poor patient outcomes. This study looks at the complications rates from the implementation of a robotics program at a single centre. Methods A retrospective review of a prospectively maintained database of oesophageal cancer patients treated at a single centre was undertaken. The robotic oesophagectomy program commenced October 2019 and all patients undergoing oesophagectomy to June 2023 were identified. Demographics, operative variables, oncological outcomes, and complications were analysed. Type of operation was robotic when at least one phase was robot-assisted, minimally invasive (MIO) when one phase was thoracosopic or laparoscopic and open when both were open. CUSUM analysis was used to determine the effect of a change in anastomotic technique due to a real time observation of an increase in anastomotic leak rate. Results 229 patients underwent oesophagectomy; 67 robotic, 40 MIO and 122 open. Clinical stage, demographics, and CPEX parameters were similar. There were slightly fewer complications in the robotic group overall (robotic 71.6%, MIO 72.5%, Open 74.2%); this was not statistically significant. There were significantly more anastomotic leaks in the robotic group (19.4%) compared to open (12.9%) which was noted in real time and led to a change in anastomotic technique with CUSUM analysis after this showed a diminished anastomotic leak rate (0/9 cases). Chyle leak occurred in 6% of robotic and 4% of open cases, which was not significantly different. Conclusions We found that the outcomes following robotic oesophagectomy were mostly comparable to conventional techniques. Whilst we found no difference in overall complications, there was a significantly higher anastomotic leak rate observed and identified which led to a change in anastomotic technique. Early results from this indicates a significant reduction in anastomotic leakage. It is crucial that all centres adopting the robotic platform closely monitor outcomes in real-time.

Intractable chylous leak after radical esophagectomy treated with radiotherapy

Postoperative chylous leak after esophagectomy is a rare but potentially life-threatening complication that results in hypovolemia, electrolyte imbalance, malnutrition, and immunologic deficiency. However, the management of postoperative chylous leak remains controversial. Following a diagnosis of esophageal cancer, a 64-year-old man was treated by video-assisted thoracoscopic esophagectomy, laparoscopic gastric tube formation, prophylactically thoracic duct ligation, and reconstruction with esophagogastrostomy at the neck level. Massive postoperative drainage from the thorax and abdomen did not initially meet the diagnostic criteria for chylothorax, which was ultimately diagnosed 3 weeks after the operation. Despite various treatments including total parenteral nutrition, octreotide and midodrine, reoperation (thoracic duct ligation and mechanical pleurodesis), and thoracic duct embolization, the chylous leak persisted. Finally, low-dose radiation therapy was administered with a daily dose of 2 Gy and completed at a total dose of 14 Gy. After this, the amount of pleural effusion gradually decreased over 2 weeks, and the last drainage tube was removed. The patient was alive and well at 60 months postoperatively. Herein, we describe a patient with intractable chylous leak after esophagectomy, which persisted despite conservative treatment, thoracic duct ligation, and embolization, but was finally successfully treated with radiotherapy.

Survival and surgical outcomes of robotic versus open pancreatoduodenectomy for ampullary cancer: A propensity score-matching comparison

Background/objectiveRobotic pancreaticoduodenectomy in ampullary cancer has never been studied. This study aimed to clarify the feasibility and justification of robotic pancreaticoduodenectomy in ampullary cancer in terms of surgical risks, and oncologic and survival outcomes. MethodsA propensity score-matching comparison of robotic and open pancreaticoduodenectomy based on seven factors commonly used to predict the survival outcomes in ampullary cancer patients. ResultsA total of 147 patients were enrolled, of which 101 and 46 underwent robotic and open pancreaticoduodenectomies, respectively. After propensity score-matching with a 2:1 ratio, 88 and 44 patients in the robotic and open pancreaticoduodenectomy groups were included. The operation time was of no significant difference after matching. The median intraoperative blood loss was much less in those who underwent robotic pancreaticoduodenectomy, both before (median, 120 vs. 320 c.c. P < 0.001) and after (100 vs. 335 mL P < 0.001) score-matching. There were no significant differences in terms of surgical risks, including surgical mortality, surgical morbidity, Clavien-Dindo severity classification, postoperative pancreatic fistula, delayed gastric emptying, post-pancreatectomy hemorrhage, chyle leak, bile leak, and wound infection, both before or after score-matching. The survival outcomes were also similar between the two groups, regardless of matching. ConclusionsRobotic pancreaticoduodenectomy for ampullary cancer is not only technically feasible and safe without increasing surgical risks, but also oncologically justifiable without compromising surgical radicality and survival outcomes.

An Under-Recognized Complication of Chylous Leak: A Case Report of Rapidly Developed Hyponatremia

An Under-Recognized Complication of Chylous Leak: A Case Report of Rapidly Developed Hyponatremia

Bilateral Pleural Chylothorax from A Blunt Chest Trauma

Introduction: Bilateral traumatic chylothorax is a very rare condition. Approximately80% of chylothorax are unilateral and usually 2/3 of cases on the right side [1]. The chyle leakage shows a milky white appearance, inexhaustible, in a consideration amount. Purpose: To report the management of bilateral traumatic chylothorax as a very rare condition. Material and methods: We present a patient with bilateral pleural chylothorax from a blunt chest trauma which is combined with a vertebral thoracal fracture of Th8, Th10.We present the diagnostic basis, treatment and evolution of chilies leakage. Results: A 36 years old man involved in a car crash. He was hospitalized with a diagnose such as right pleural effusion and thoracal vertebral fractures of the Th8, Th10.2 days after trauma the scan examination showed a large amount of effusion in the right hemithorax and minimal effusion in the left hemithorax. From the drainage tube in the right pleural cavity there was a flow of about 1000ml with a milky appearance. The biochemical analyses of the pleural effusion showed the presence of triglycerides with more than 1.24mmol /l and the cholesterol level with less than 5.18mmol/l which support the diagnosis of chylothorax. Initial treatment was conservative. A zero nutritional regimen was implemented for the first 10 days, being replaced by total parenteral nutrition such as plasma, albumin, electrolytes, vitamins. After that we passed to a fat-free nutritional diet. In the scan examination 6 days after the trauma, there was an increase in the amount of pleural effusion on the left side. A chest tube was performed from which there was 700 ml leakage, which had the appearance of chyle. The biochemical tests confirmed the diagnose of chylothorax. The chest tube of the left pleural cavity was removed after 5 days. The chyle leakage from the right pleural cavity has continued for about 3 weeks in a quantity ranging from 150-300 ml in 24 hours. After this period, approximately for 1 week the chyle leakage was in an amount of less than 1000ml in 24 hours. In the 5th week, the chest tube was removed, since the leaks were reduced to about 20-30 ml in 24 hours. The patient left the hospital after 30 days. The patient was completely recovered. Conclusions: The case was managed conservatively, based on a bilateral pleural drainage and a diet without fats, which proved to be successful.