Risk Factors, Diagnosis and Management of Chyle Leak Following Esophagectomy for Cancers
Objective:. 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 asso...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Health
2022-09-01
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| Series: | Annals of Surgery Open |
| Online Access: | http://journals.lww.com/10.1097/AS9.0000000000000192 |
| _version_ | 1827856012870156288 |
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| author | Sivesh K. Kamarajah, BMedSci, MBChB, MRCS Manjunath Siddaiah-Subramanya, MD Alessandro Parente, MD Richard P. T. Evans, MRCS, MBChB Ademola Adeyeye, MD Alan Ainsworth, MD Alberto M. L. Takahashi, MD Alex Charalabopoulos, MD Andrew Chang, MD Atila Eroglue, MD Bas Wijnhoven, MD Claire Donohoe, MD Daniela Molena, MD Eider Talavera-Urquijo, MD Flavio Roberto Takeda, MD Gail Darling, MD German Rosero, MD Guillaume Piessen, MD Hans Mahendran, MD Hsu Po Kuei, MD Ines Gockel, MD Ionut Negoi, MD Jacopo Weindelmayer, MD Jari Rasanen, MD Kebebe Bekele, MD Guowei Kim, MD Lieven Depypere, MD Lorenzo Ferri, MD Magnus Nilsson, MD Frederik Klevebro, MD B. Mark Smithers, MD Mark I. van Berge Henegouwen, MD Peter Grimminger, MD Paul M. Schneider, MD C. S. Pramesh, MD Raza Sayyed, MD Richard Babor, MD Shinji Mine, MD Simon Law, MD Suzanne Gisbertz, MD Tim Bright, MD Xavier Benoit D’Journo, MD Donald Low, MD Pritam Singh, PhD FRCS Ewen A Griffiths, MD, FRCS on behalf of the Oesophagogastric Anastomosis Audit collaborative |
| author_facet | Sivesh K. Kamarajah, BMedSci, MBChB, MRCS Manjunath Siddaiah-Subramanya, MD Alessandro Parente, MD Richard P. T. Evans, MRCS, MBChB Ademola Adeyeye, MD Alan Ainsworth, MD Alberto M. L. Takahashi, MD Alex Charalabopoulos, MD Andrew Chang, MD Atila Eroglue, MD Bas Wijnhoven, MD Claire Donohoe, MD Daniela Molena, MD Eider Talavera-Urquijo, MD Flavio Roberto Takeda, MD Gail Darling, MD German Rosero, MD Guillaume Piessen, MD Hans Mahendran, MD Hsu Po Kuei, MD Ines Gockel, MD Ionut Negoi, MD Jacopo Weindelmayer, MD Jari Rasanen, MD Kebebe Bekele, MD Guowei Kim, MD Lieven Depypere, MD Lorenzo Ferri, MD Magnus Nilsson, MD Frederik Klevebro, MD B. Mark Smithers, MD Mark I. van Berge Henegouwen, MD Peter Grimminger, MD Paul M. Schneider, MD C. S. Pramesh, MD Raza Sayyed, MD Richard Babor, MD Shinji Mine, MD Simon Law, MD Suzanne Gisbertz, MD Tim Bright, MD Xavier Benoit D’Journo, MD Donald Low, MD Pritam Singh, PhD FRCS Ewen A Griffiths, MD, FRCS on behalf of the Oesophagogastric Anastomosis Audit collaborative |
| author_sort | Sivesh K. Kamarajah, BMedSci, MBChB, MRCS |
| collection | DOAJ |
| description | Objective:. 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. |
| first_indexed | 2024-03-12T12:18:40Z |
| format | Article |
| id | doaj.art-5bce814ed4fb4b12b9596a66bbc8a4c8 |
| institution | Directory Open Access Journal |
| issn | 2691-3593 |
| language | English |
| last_indexed | 2024-03-12T12:18:40Z |
| publishDate | 2022-09-01 |
| publisher | Wolters Kluwer Health |
| record_format | Article |
| series | Annals of Surgery Open |
| spelling | doaj.art-5bce814ed4fb4b12b9596a66bbc8a4c82023-08-30T06:10:24ZengWolters Kluwer HealthAnnals of Surgery Open2691-35932022-09-0133e19210.1097/AS9.0000000000000192202209000-00022Risk Factors, Diagnosis and Management of Chyle Leak Following Esophagectomy for CancersSivesh K. Kamarajah, BMedSci, MBChB, MRCS0Manjunath Siddaiah-Subramanya, MD1Alessandro Parente, MD2Richard P. T. Evans, MRCS, MBChB3Ademola Adeyeye, MD4Alan Ainsworth, MD5Alberto M. L. Takahashi, MD6Alex Charalabopoulos, MD7Andrew Chang, MD8Atila Eroglue, MD9Bas Wijnhoven, MD10Claire Donohoe, MD11Daniela Molena, MD12Eider Talavera-Urquijo, MD13Flavio Roberto Takeda, MD14Gail Darling, MD15German Rosero, MD16Guillaume Piessen, MD17Hans Mahendran, MD18Hsu Po Kuei, MD19Ines Gockel, MD20Ionut Negoi, MD21Jacopo Weindelmayer, MD22Jari Rasanen, MD23Kebebe Bekele, MD24Guowei Kim, MD25Lieven Depypere, MD26Lorenzo Ferri, MD27Magnus Nilsson, MD28Frederik Klevebro, MD29B. Mark Smithers, MD30Mark I. van Berge Henegouwen, MD31Peter Grimminger, MD32Paul M. Schneider, MD33C. S. Pramesh, MD34Raza Sayyed, MD35Richard Babor, MD36Shinji Mine, MD37Simon Law, MD38Suzanne Gisbertz, MD39Tim Bright, MD40Xavier Benoit D’Journo, MD41Donald Low, MD42Pritam Singh, PhD FRCS43Ewen A Griffiths, MD, FRCS44on behalf of the Oesophagogastric Anastomosis Audit collaborativeFrom the * Department of Upper Gastrointestinal Surgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Trust, Birmingham, United KingdomFrom the * Department of Upper Gastrointestinal Surgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Trust, Birmingham, United Kingdom§ Department of Hepatobiliary Surgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Trust, Birmingham, United KingdomFrom the * Department of Upper Gastrointestinal Surgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Trust, Birmingham, United Kingdom∥ The Division of Surgical Oncology, Department of Surgery, Afe Babalola University (ABUAD), Nigeria¶ Odense University Hospital, Denmark# Department of Gastrointestinal Tumors, National Cancer Institute, Mexico City, MX** Laikon General Hospital, Greece†† Section of Thoracic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI‡‡ Department of Thoracic Surgery, Medical Faculty, Ataturk University, Erzurum, Turkey§§ Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands∥∥ Department of Surgery, Trinity College Dublin, St James’s Hospital, Dublin, Ireland¶¶ Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY## Department of Surgery, San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy*** Gastroenterology Department, University of São Paulo, São Paulo, Brazil††† Department of Thoracic Surgery, Toronto General Hospital, Toronto, ON, Canada‡‡‡ Hospital San Ignacio-Universidad Javeriana, Colombia§§§ CNRS, Inserm, CHU Lille, UMR9020-U1277—CANTHER—Cancer Heterogeneity Plasticity and Resistance to Therapies, University of Lille, Lille, France∥∥∥ Hospital Sultanah Aminah, Johor Bahru, Malaysia¶¶¶ Taipei Veterans General Hospital, Taiwan### Department of Visceral, Transplant, Thoracic and Vascular Surgery, University of Leipzig, Germany**** Emergency Hospital of Bucharest, Romania†††† General and Upper G.I. Surgery Division, University of Verona, Verona, Italy‡‡‡‡ Department of Thoracic Surgery, Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland§§§§ School of Medicine, Department of Surgery, Madda Walabu University Goba Referral Hospital, Bale-Goba, Ethiopia∥∥∥∥ National University Hospital, University Surgical Cluster, Singapore¶¶¶¶ Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium#### Department of Thoracic Surgery and Upper Gastrointestinal Surgery, McGill University, Montreal, Canada***** Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden***** Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden††††† Department of Surgery, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia‡‡‡‡‡ Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands§§§§§ Department of General-, Visceral- and Transplant Surgery, University Medical Center of the Johannes Gutenberg University, Mainz, Germany∥∥∥∥∥ Department of Digestive and Oncological Surgery, Hirslanden Medical Center, Zurich, Switzerland¶¶¶¶¶ Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India##### Department of Surgical Oncology, Patel Hospital, Karachi, Pakistan****** Department of General Surgery, Middlemore Hospital, Auckland, New Zealand†††††† Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan‡‡‡‡‡‡ Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China‡‡‡‡‡ Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands§§§§§§ Department of Oesophago-gastric Surgery, Flinders Medical Centre, Australia∥∥∥∥∥∥ Department of Thoracic Surgery, Aix-Marseille University, North Hospital, Marseille, France¶¶¶¶¶¶ Department of Thoracic Surgery, Virginia Mason Medical Center, Seattle, Washington, DC###### Regional Oesophago-Gastric Unit, Royal Surrey County Hospital NHS Foundation Trust, Guildford, United Kingdom.From the * Department of Upper Gastrointestinal Surgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Trust, Birmingham, United KingdomObjective:. 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.http://journals.lww.com/10.1097/AS9.0000000000000192 |
| spellingShingle | Sivesh K. Kamarajah, BMedSci, MBChB, MRCS Manjunath Siddaiah-Subramanya, MD Alessandro Parente, MD Richard P. T. Evans, MRCS, MBChB Ademola Adeyeye, MD Alan Ainsworth, MD Alberto M. L. Takahashi, MD Alex Charalabopoulos, MD Andrew Chang, MD Atila Eroglue, MD Bas Wijnhoven, MD Claire Donohoe, MD Daniela Molena, MD Eider Talavera-Urquijo, MD Flavio Roberto Takeda, MD Gail Darling, MD German Rosero, MD Guillaume Piessen, MD Hans Mahendran, MD Hsu Po Kuei, MD Ines Gockel, MD Ionut Negoi, MD Jacopo Weindelmayer, MD Jari Rasanen, MD Kebebe Bekele, MD Guowei Kim, MD Lieven Depypere, MD Lorenzo Ferri, MD Magnus Nilsson, MD Frederik Klevebro, MD B. Mark Smithers, MD Mark I. van Berge Henegouwen, MD Peter Grimminger, MD Paul M. Schneider, MD C. S. Pramesh, MD Raza Sayyed, MD Richard Babor, MD Shinji Mine, MD Simon Law, MD Suzanne Gisbertz, MD Tim Bright, MD Xavier Benoit D’Journo, MD Donald Low, MD Pritam Singh, PhD FRCS Ewen A Griffiths, MD, FRCS on behalf of the Oesophagogastric Anastomosis Audit collaborative Risk Factors, Diagnosis and Management of Chyle Leak Following Esophagectomy for Cancers Annals of Surgery Open |
| title | Risk Factors, Diagnosis and Management of Chyle Leak Following Esophagectomy for Cancers |
| title_full | Risk Factors, Diagnosis and Management of Chyle Leak Following Esophagectomy for Cancers |
| title_fullStr | Risk Factors, Diagnosis and Management of Chyle Leak Following Esophagectomy for Cancers |
| title_full_unstemmed | Risk Factors, Diagnosis and Management of Chyle Leak Following Esophagectomy for Cancers |
| title_short | Risk Factors, Diagnosis and Management of Chyle Leak Following Esophagectomy for Cancers |
| title_sort | risk factors diagnosis and management of chyle leak following esophagectomy for cancers |
| url | http://journals.lww.com/10.1097/AS9.0000000000000192 |
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