TY - JOUR
T1 - Risk Factors, Diagnosis and Management of Chyle Leak Following Esophagectomy for Cancers
T2 - An International Consensus Statement
AU - Kamarajah, Sivesh K
AU - Siddaiah-Subramanya, Manjunath
AU - Parente, Alessandro
AU - Evans, Richard P T
AU - Adeyeye, Ademola
AU - Ainsworth, Alan
AU - Takahashi, Alberto M L
AU - Charalabopoulos, Alex
AU - Chang, Andrew
AU - Eroglue, Atila
AU - Wijnhoven, Bas
AU - Donohoe, Claire
AU - Molena, Daniela
AU - Talavera-Urquijo, Eider
AU - Takeda, Flavio Roberto
AU - Darling, Gail
AU - Rosero, German
AU - Piessen, Guillaume
AU - Mahendran, Hans
AU - Kuei, Hsu Po
AU - Gockel, Ines
AU - Negoi, Ionut
AU - Weindelmayer, Jacopo
AU - Rasanen, Jari
AU - Bekele, Kebebe
AU - Kim, Guowei
AU - Depypere, Lieven
AU - Ferri, Lorenzo
AU - Nilsson, Magnus
AU - Klevebro, Frederik
AU - Smithers, B Mark
AU - van Berge Henegouwen, Mark I
AU - Grimminger, Peter
AU - Schneider, Paul M
AU - Pramesh, C S
AU - Sayyed, Raza
AU - Babor, Richard
AU - Mine, Shinji
AU - Law, Simon
AU - Gisbertz, Suzanne
AU - Bright, Tim
AU - Benoit D'Journo, Xavier
AU - Low, Donald
AU - Singh, Pritam
AU - Griffiths, Ewen A
N1 - Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.
PY - 2022/9
Y1 - 2022/9
N2 - UNLABELLED: This Delphi exercise aimed to gather consensus surrounding risk factors, diagnosis, and management of chyle leaks after esophagectomy and to develop recommendations for clinical practice.BACKGROUND: Chyle leaks following esophagectomy for malignancy are uncommon. Although they are associated with increased morbidity and mortality, diagnosis and management of these patients remain controversial and a challenge globally.METHODS: This was a modified Delphi exercise was delivered to clinicians across the oesophagogastric anastomosis collaborative. A 5-staged iterative process was used to gather consensus on clinical practice, including a scoping systematic review (stage 1), 2 rounds of anonymous electronic voting (stages 2 and 3), data-based analysis (stage 4), and guideline and consensus development (stage 5). Stratified analyses were performed by surgeon specialty and surgeon volume.RESULTS: In stage 1, the steering committee proposed areas of uncertainty across 5 domains: risk factors, intraoperative techniques, and postoperative management (ie, diagnosis, severity, and treatment). In stages 2 and 3, 275 and 250 respondents respectively participated in online voting. Consensus was achieved on intraoperative thoracic duct ligation, postoperative diagnosis by milky chest drain output and biochemical testing with triglycerides and chylomicrons, assessing severity with volume of chest drain over 24 hours and a step-up approach in the management of chyle leaks. Stratified analyses demonstrated consistent results. In stage 4, data from the Oesophagogastric Anastomosis Audit demonstrated that chyle leaks occurred in 5.4% (122/2247). Increasing chyle leak grades were associated with higher rates of pulmonary complications, return to theater, prolonged length of stay, and 90-day mortality. In stage 5, 41 surgeons developed a set of recommendations in the intraoperative techniques, diagnosis, and management of chyle leaks.CONCLUSIONS: Several areas of consensus were reached surrounding diagnosis and management of chyle leaks following esophagectomy for malignancy. Guidance in clinical practice through adaptation of recommendations from this consensus may help in the prevention of, timely diagnosis, and management of chyle leaks.
AB - UNLABELLED: This Delphi exercise aimed to gather consensus surrounding risk factors, diagnosis, and management of chyle leaks after esophagectomy and to develop recommendations for clinical practice.BACKGROUND: Chyle leaks following esophagectomy for malignancy are uncommon. Although they are associated with increased morbidity and mortality, diagnosis and management of these patients remain controversial and a challenge globally.METHODS: This was a modified Delphi exercise was delivered to clinicians across the oesophagogastric anastomosis collaborative. A 5-staged iterative process was used to gather consensus on clinical practice, including a scoping systematic review (stage 1), 2 rounds of anonymous electronic voting (stages 2 and 3), data-based analysis (stage 4), and guideline and consensus development (stage 5). Stratified analyses were performed by surgeon specialty and surgeon volume.RESULTS: In stage 1, the steering committee proposed areas of uncertainty across 5 domains: risk factors, intraoperative techniques, and postoperative management (ie, diagnosis, severity, and treatment). In stages 2 and 3, 275 and 250 respondents respectively participated in online voting. Consensus was achieved on intraoperative thoracic duct ligation, postoperative diagnosis by milky chest drain output and biochemical testing with triglycerides and chylomicrons, assessing severity with volume of chest drain over 24 hours and a step-up approach in the management of chyle leaks. Stratified analyses demonstrated consistent results. In stage 4, data from the Oesophagogastric Anastomosis Audit demonstrated that chyle leaks occurred in 5.4% (122/2247). Increasing chyle leak grades were associated with higher rates of pulmonary complications, return to theater, prolonged length of stay, and 90-day mortality. In stage 5, 41 surgeons developed a set of recommendations in the intraoperative techniques, diagnosis, and management of chyle leaks.CONCLUSIONS: Several areas of consensus were reached surrounding diagnosis and management of chyle leaks following esophagectomy for malignancy. Guidance in clinical practice through adaptation of recommendations from this consensus may help in the prevention of, timely diagnosis, and management of chyle leaks.
U2 - https://doi.org/10.1097/AS9.0000000000000192
DO - https://doi.org/10.1097/AS9.0000000000000192
M3 - Article
C2 - 36199483
SN - 2691-3593
VL - 3
SP - e192
JO - Annals of surgery open : perspectives of surgical history, education, and clinical approaches
JF - Annals of surgery open : perspectives of surgical history, education, and clinical approaches
IS - 3
ER -