Chylous Leakage After Retroperitoneal Minimally Invasive Surgery: A Multi-institutional Analysis of Risk Factors,...

To clarify the management approach for chylous leakage after retroperitoneal minimally invasive surgeries by investigating risk factors and clinical course with a video of the case requiring surgical intervention.

This retrospective study included 1258 patients who underwent minimally invasive retroperitoneal surgeries at 4 Japanese institutions between 2010 and 2023. We analyzed the risk factors for the onset of postoperative chylous leakage and reviewed the clinical courses in patients with chylous leakage, with a detailed evaluation of cases requiring surgical intervention.

Chylous leakage occurred exclusively on the left in 2.1% (27/1258) of cases. It was associated with lymph node dissection (n = 22) or excessive hilar dissection around the left renal pedicle (n = 5). Multivariate analysis identified left-sided surgery and lymph node dissection as significant risk factors. Conservative management, including dietary therapy with or without octreotide, was effective in 25 cases (94%). However, 2 cases (6%) required surgical repair for persistent chylous leakage. In both cases, preoperative ingestion of fatty substances facilitated accurate intraoperative identification of the leakage site, allowing successful laparoscopic closure.

Chylous leakage is a notable postoperative complication of para-aortic lymph node dissection and extensive left hilar dissection during minimally invasive retroperitoneal surgeries. Although conservative management is effective in most cases, laparoscopic repair with preoperative fatty substance administration is a viable option for refractory cases.