Risk factors and prevention of chylous leakage after pancreaticoduodenectomy

Objective To investigate the risk factors of chylous leakage after pancreatioduodenectomy so as to find effective measures to prevent this complication. Methods A retrospective analysis was conducted on 230 patients who underwent pancreatioduodenectomy at the First Affiliated Hospital of Zhejiang University from Jun. 2012 to Jun. 2014. Patients with chylous leakage were identified and a 1∶2 patients in the study and the control groups were selected. The parameters for matching included tumor volume, vascular invasion, and extent of lymph node dissection. A logistic analysis was performed to identify independent risk factors of chylous leakage. Results 15 (6.5%) patients developed chylous leakage after pancreatioduodenectomy. The average hospital stay after surgery of the study group was 20.8 days, compared to 13.5 days in the control-group (P=0.004). In the study group, chylous leakage rate increased in patients with 14th and 16th group of lymph nodes dissection (80% vs 36.7%, P=0.006). Logistic analysis showed that 14th and 16th lymph nodes dissection was an independent risk factor of chylous leakage after pancreatioduodenectomy (P<0.05, OR=6.909, 95%CI 1.593~29.958). Conclusions Chylous leakage prolonged hospitalization after pancreatioduodenectomy. Dissection of the 14th and 16th lymph node groups was an independent risk factor of chylous leakage after pancreatioduodenectomy. Careful ligation of the gastrocolic vein near the lymphatic trunk and dissection of 14th and 16th group of lymph nodes were effective interventions to reduce postoperative chylous leakage. Key words: Pancreatoduodenectomy; Chylous leakage; Lymph node dissection; Total parenteral nutrition