Title :

Risk Factors, Diagnosis and Management of Chyle Leak Following Esophagectomy for Cancers

Author(s) :

Kamarajah, Sivesh [Auteur]
Newcastle Upon Tyne Hospitals NHS Foundation Trust
Siddaiah-Subramanya, Manjunath [Auteur]
Parente, Alessandro [Auteur]
Université libre de Bruxelles [ULB]
Evans, Richard [Auteur]
University of Westminster [London] [UOW]
Adeyeye, Ademola [Auteur]
Ainsworth, Alan [Auteur]
Takahashi, Alberto [Auteur]
Charalabopoulos, Alex [Auteur]
Chang, Andrew [Auteur]
McMaster University [Hamilton, Ontario]
Eroglue, Atila [Auteur]
Wijnhoven, Bas [Auteur]
Donohoe, Claire [Auteur]
Molena, Daniela [Auteur]
Talavera-Urquijo, Eider [Auteur]
Takeda, Flavio Roberto [Auteur]
Darling, Gail [Auteur]
Rosero, German [Auteur]
Piessen, Guillaume [Auteur]
Hétérogénéité, Plasticité et Résistance aux Thérapies des Cancers = Cancer Heterogeneity, Plasticity and Resistance to Therapies - UMR 9020 - U 1277 [CANTHER]
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Mahendran, Hans [Auteur]
Kuei, Hsu Po [Auteur]
Gockel, Ines [Auteur]
Negoi, Ionut [Auteur]
Weindelmayer, Jacopo [Auteur]
Rasanen, Jari [Auteur]
Bekele, Kebebe [Auteur]
Kim, Guowei [Auteur]
Depypere, Lieven [Auteur]
Ferri, Lorenzo [Auteur]
Nilsson, Magnus [Auteur]
Klevebro, Frederik [Auteur]
Smithers, B. Mark [Auteur]
van Berge Henegouwen, Mark [Auteur]
Grimminger, Peter [Auteur]
Schneider, Paul [Auteur]
Pramesh, C. [Auteur]
Sayyed, Raza [Auteur]
Babor, Richard [Auteur]
Mine, Shinji [Auteur]
Law, Simon [Auteur]
Gisbertz, Suzanne [Auteur]
Bright, Tim [Auteur]
Benoit D’journo, Xavier [Auteur]
Low, Donald [Auteur]
Singh, Pritam [Auteur]
Griffiths, Ewen [Auteur]

Journal title :

Annals of Surgery Open

Pages :

e192

Publisher :

Lippincott, Williams & Wilkins

Publication date :

2022-09-29

ISSN :

2691-3593

HAL domain(s) :

Sciences du Vivant [q-bio]/Cancer

English abstract : [en]

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 ...
Show more >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.Show less >

Language :

Anglais

Peer reviewed article :

Oui

Audience :

Internationale

Popular science :

Non

Collections :

• Cancer Heterogeneity, Plasticity and Resistance to Therapies (CANTHER) - UMR 9020 - UMR 1277

Source :

Harvested from HAL