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Risk Factors, Diagnosis and Management of Chyle Leak Following Esophagectomy for Cancers: An International Consensus Statement
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 associ...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer Health, Inc.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9508983/ https://www.ncbi.nlm.nih.gov/pubmed/36199483 http://dx.doi.org/10.1097/AS9.0000000000000192 |
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author | Kamarajah, Sivesh K. Siddaiah-Subramanya, Manjunath Parente, Alessandro Evans, Richard P. T. Adeyeye, Ademola Ainsworth, Alan Takahashi, Alberto M. L. Charalabopoulos, Alex Chang, Andrew Eroglue, Atila Wijnhoven, Bas Donohoe, Claire Molena, Daniela Talavera-Urquijo, Eider Takeda, Flavio Roberto Darling, Gail Rosero, German Piessen, Guillaume Mahendran, Hans Kuei, Hsu Po Gockel, Ines Negoi, Ionut Weindelmayer, Jacopo Rasanen, Jari Bekele, Kebebe Kim, Guowei Depypere, Lieven Ferri, Lorenzo Nilsson, Magnus Klevebro, Frederik Smithers, B. Mark van Berge Henegouwen, Mark I. Grimminger, Peter Schneider, Paul M. Pramesh, C. S. Sayyed, Raza Babor, Richard Mine, Shinji Law, Simon Gisbertz, Suzanne Bright, Tim Benoit D’Journo, Xavier Low, Donald Singh, Pritam Griffiths, Ewen A |
author_facet | Kamarajah, Sivesh K. Siddaiah-Subramanya, Manjunath Parente, Alessandro Evans, Richard P. T. Adeyeye, Ademola Ainsworth, Alan Takahashi, Alberto M. L. Charalabopoulos, Alex Chang, Andrew Eroglue, Atila Wijnhoven, Bas Donohoe, Claire Molena, Daniela Talavera-Urquijo, Eider Takeda, Flavio Roberto Darling, Gail Rosero, German Piessen, Guillaume Mahendran, Hans Kuei, Hsu Po Gockel, Ines Negoi, Ionut Weindelmayer, Jacopo Rasanen, Jari Bekele, Kebebe Kim, Guowei Depypere, Lieven Ferri, Lorenzo Nilsson, Magnus Klevebro, Frederik Smithers, B. Mark van Berge Henegouwen, Mark I. Grimminger, Peter Schneider, Paul M. Pramesh, C. S. Sayyed, Raza Babor, Richard Mine, Shinji Law, Simon Gisbertz, Suzanne Bright, Tim Benoit D’Journo, Xavier Low, Donald Singh, Pritam Griffiths, Ewen A |
author_sort | Kamarajah, Sivesh K. |
collection | PubMed |
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. |
format | Online Article Text |
id | pubmed-9508983 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Wolters Kluwer Health, Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-95089832022-10-03 Risk Factors, Diagnosis and Management of Chyle Leak Following Esophagectomy for Cancers: An International Consensus Statement Kamarajah, Sivesh K. Siddaiah-Subramanya, Manjunath Parente, Alessandro Evans, Richard P. T. Adeyeye, Ademola Ainsworth, Alan Takahashi, Alberto M. L. Charalabopoulos, Alex Chang, Andrew Eroglue, Atila Wijnhoven, Bas Donohoe, Claire Molena, Daniela Talavera-Urquijo, Eider Takeda, Flavio Roberto Darling, Gail Rosero, German Piessen, Guillaume Mahendran, Hans Kuei, Hsu Po Gockel, Ines Negoi, Ionut Weindelmayer, Jacopo Rasanen, Jari Bekele, Kebebe Kim, Guowei Depypere, Lieven Ferri, Lorenzo Nilsson, Magnus Klevebro, Frederik Smithers, B. Mark van Berge Henegouwen, Mark I. Grimminger, Peter Schneider, Paul M. Pramesh, C. S. Sayyed, Raza Babor, Richard Mine, Shinji Law, Simon Gisbertz, Suzanne Bright, Tim Benoit D’Journo, Xavier Low, Donald Singh, Pritam Griffiths, Ewen A Ann Surg Open Original Study 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. Wolters Kluwer Health, Inc. 2022-08-29 /pmc/articles/PMC9508983/ /pubmed/36199483 http://dx.doi.org/10.1097/AS9.0000000000000192 Text en Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY) (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Study Kamarajah, Sivesh K. Siddaiah-Subramanya, Manjunath Parente, Alessandro Evans, Richard P. T. Adeyeye, Ademola Ainsworth, Alan Takahashi, Alberto M. L. Charalabopoulos, Alex Chang, Andrew Eroglue, Atila Wijnhoven, Bas Donohoe, Claire Molena, Daniela Talavera-Urquijo, Eider Takeda, Flavio Roberto Darling, Gail Rosero, German Piessen, Guillaume Mahendran, Hans Kuei, Hsu Po Gockel, Ines Negoi, Ionut Weindelmayer, Jacopo Rasanen, Jari Bekele, Kebebe Kim, Guowei Depypere, Lieven Ferri, Lorenzo Nilsson, Magnus Klevebro, Frederik Smithers, B. Mark van Berge Henegouwen, Mark I. Grimminger, Peter Schneider, Paul M. Pramesh, C. S. Sayyed, Raza Babor, Richard Mine, Shinji Law, Simon Gisbertz, Suzanne Bright, Tim Benoit D’Journo, Xavier Low, Donald Singh, Pritam Griffiths, Ewen A Risk Factors, Diagnosis and Management of Chyle Leak Following Esophagectomy for Cancers: An International Consensus Statement |
title | Risk Factors, Diagnosis and Management of Chyle Leak Following Esophagectomy for Cancers: An International Consensus Statement |
title_full | Risk Factors, Diagnosis and Management of Chyle Leak Following Esophagectomy for Cancers: An International Consensus Statement |
title_fullStr | Risk Factors, Diagnosis and Management of Chyle Leak Following Esophagectomy for Cancers: An International Consensus Statement |
title_full_unstemmed | Risk Factors, Diagnosis and Management of Chyle Leak Following Esophagectomy for Cancers: An International Consensus Statement |
title_short | Risk Factors, Diagnosis and Management of Chyle Leak Following Esophagectomy for Cancers: An International Consensus Statement |
title_sort | risk factors, diagnosis and management of chyle leak following esophagectomy for cancers: an international consensus statement |
topic | Original Study |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9508983/ https://www.ncbi.nlm.nih.gov/pubmed/36199483 http://dx.doi.org/10.1097/AS9.0000000000000192 |
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