Comprehensive Analysis of Chyle Leak in Resected Pancreatic Head Cancer: Impact on Clinical, Oncologic, and Nutritional Outcomes

Abstract

Background Chyle leak (CL) is a relevant complication of pancreatic surgery, but its incidence, risk factors, clinical and oncologic impacts, and nutritional relevance remain inconsistent and limited. Methods We retrospectively reviewed patients who underwent pancreaticoduodenectomy for pancreatic head cancer from 2007 to 2023 at a single institution. The clinical impact of CL was evaluated by prolonged hospital stays and immune-nutritional status, assessed using the Controlling Nutritional Status (CONUT) score at discharge. Oncologic impact included the administration of adjuvant chemotherapy, the surgery-to-chemotherapy interval, overall survival (OS), and recurrence-free survival (RFS). Predictors of CL were identified through multivariate analyses. Results CL occurred in 70 patients (13.8%) and was significantly associated with prolonged hospital stay (OR: 1.947, p = 0.045) and poor CONUT score at discharge (> 6; OR: 1.820, p = 0.036). CL did not significantly impact oncologic outcomes, including adjuvant chemotherapy (p = 0.732), surgery-to-chemotherapy interval (p = 0.235), 5-year OS (p = 0.978), or 5-year RFS (p = 0.919). Independent predictors of CL included hypertension, lymph node metastasis, delayed gastric emptying, minimally invasive surgery (MIS), and operative time. Conclusions CL is associated with prolonged hospital stay and poor nutritional status at discharge, but shows no significant impact on long-term oncologic outcomes.